Sunday, June 21, 2009

Fee Schedule

Acupuncture billing, at this time, was under the New York Workers’ Compensation Medical Fee Schedule listings (“NYWCMFS”), with identifying code numbers of 97780 and 97781, in Section 8 Physical Medicine (“PM”). Codes 97780 and 97781 provide, under the relative portion heading of the section, that Acupuncture has a BR listing. That is, billing is done by report. As defined by General Ground Rules of Section 1 Introduction and General Guidelines, subdivision 3, BR coding is used when the services are to be variable to permit assignment of unit values. Pertinent information concerning the nature, extent, and need for the procedure or service, the time, skill and equipment necessary are to be furnished. The subdivision further provides that “…the physician shall establish a unit value consistent in relativity with other unit values shown in the schedule.” The PM ground rules, subdivision 13, provides “[W]hen multiple physical medicine procedures …are performed on the same day, reimbursement is limited to 8.0 units or the amount billed, whichever is less.”
In other words, although acupuncture has a BR coding, it is limited to a maximum of 8.0 units per day and is to be correlated to other services provided in the PM section of the NYWCMFS as well as providing documentation as nature, extent, time and need for the services. A review of the PM section indicates that the majority of relative values range between 2.37 and 4.40 with 1 procedure at 28.00, 2 procedures at 9.47, 1 procedure at 5.55 and 1 procedure at 5.41. Since Acupuncture services are “variable” I assign a unit value of 6.00. Conversion factor for PM, Region IV, is $8.45. Unit value 6 x’s $8.45 would be $50.70 per acupuncture session. There were 6 sessions @ $50.70 is a total of $304.20.

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