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ORR # 2003-025 DEPARTMENT OF COMMUNITY HEALTH HEALTH PROGRAMS ADMINISTRATION
BUREAU OF CHILDREN AND FAMILY PROGRAMS HEARING SCREENING OF PRESCHOOL AND SCHOOL-AGE CHILDREN
Filed with the Secretary of State on
These rules take effect 15 days after filing with the Secretary of State.
(By authority conferred on the department of public health by sections 2226(d), 2233, and 9321 of Act No. 368 of the Public Acts of 1978, as amended, and section 9 of Act No. 380 of the Public Acts of 1965, as amended, being §333.2226(d), 333.2233, 333.9321, and 16.109 of the Michigan Compiled Laws)
R 325.3274 of the Michigan Administrative Code is amended as follows: R 325.3271 DefinitionS.
Rule 1. (1) As used in these rules:
(A) "Clinic" means a place where hearing screening is done, such as a school, a nursery, or a local health department facility.
(B) "Code" means Act No. 368 of the Public Acts of 1978,as amended, being S333.1101 et seq. of the Michigan Compiled Laws.
(C) "Screening” means the overall procedure which employs number of tests designed to determine whether or not an individual is at risk of hearing loss.
(D) "Test" means an individual specific procedure used to determine whether or not an individual is at risk of hearing loss.
(2) Unless the context requires otherwise, words or phrases used in these rules shall have the meanings ascribed to them in the code.
History: 1979 ACS 6, Eff. May 8, 1981.
R 325.3272 Hearing screening.
Rule 2. (1) Hearing screening for children who are 3 years old or older shall include audiometric tests.
(2) The procedures used in hearing screening shall be approved by the department. History: 1979 ACS 6, Eff. May 8, 1981.
R 325.3273 Administration of hearing screening and tests by properly trained and qualified individuals is required.
Rule 3. Public health hearing screening
and hearingtests shall be given by individuals trained and qualified to properly administer the screening tests. Their training and qualifications shall be approved by the department.History: 1979 ACS 6, Eff. May 8, 1981.
R 325.3274 Frequency of screening.
Rule 4. (1) Hearing screening of preschool children shall be done at least once during the ages of 3 to 5 years.
(2) Hearing screening of school-age children shall be done at least in grades K, 2, 4,
and 6, or screening shall be done at least biennially starting at age 5 and continuing at least to age1210 years.History: 1979 ACS 6, Eff. May 8, 1981.
R 325.3275 Follow-up notices.
Rule 5. The statement required by section 9305 of the code shall be a written statement that an ear examination by a physician is required. The statement shall be given or sent to the parent or guardian of the child.
History: 1979 ACS 6, Eff. May 8, 1981.
R 325.3276 Reporting results of hearing screening.
Rule 6. Local health departments shall report to the department the status of hearing screening within their jurisdiction. The reports shall be made on forms provided by the department.
History: 1979 ACS 6, Eff. May 8, 1981.
ORR # 2003-025 DEPARTMENT OF COMMUNITY HEALTH HEALTH PROGRAMS ADMINISTRATION
BUREAU OF CHILDREN AND FAMILY PROGRAMS HEARING SCREENING OF PRESCHOOL AND SCHOOL-AGE CHILDREN
Pursuant to Section 41(2) of Public Act 306 of 1969, as amended, the Department of Community Health will hold a hearing on proposed community health rules on:
Date: October 23, 2003 Location: Michigan Department of Community Health
Time: 10:30 a.m Baker-Olin West Building – Conference Room C 3423 N. Martin Luther King Jr. Boulevard Lansing, Michigan
The Proposed Rules Cover:
C R325.3274(2): Current rules require hearing screening in grades K, 2, 4 and 6. The proposed rule chance would eliminate screening in the 6th grade.
Written comments will be accepted through October 20, 2003. Please send to the Michigan Department of Community Health, attention: Mary Greco, Legal Affairs Coordinator, at the address below.
The hearing location is handicapper accessible and interpreters will be available for the hearing impaired, if requested, seven days in advance.
These rules take effect 15 days after filing with the Secretary of State.
Michigan Department of Community Health Janet Olszewski, Director
320 S. Walnut – 6th Floor Lansing, Michigan 48913
ORR # 2003-026 DEPARTMENT OF COMMUNITY HEALTH
OFFICE OF THE STATE REGISTRAR CANCER REPORTING
Filed with the Secretary of State on
These rules take effect 7 days after filing with the Secretary of State
(By authority conferred on the department of community health by section 2619 of 1978 PA 368, MCL 333.2619)
R 333.2619 Registry.
Rule 2619.(1) The department shall establish a registry to record cases of cancer and other specified tumorous and precancerous diseases that occur in the state. The registry shall include information concerning these cases as the department considers necessary and appropriate to conduct epidemiologic surveys of cancer and cancer-related diseases in the state.
(2) Each diagnosed case of cancer and other specified tumorous and precancerous diseases shall be reported to the department pursuant to subrule (4) of this rule, or reported to a cancer reporting registry if the cancer reporting registry meets standards established pursuant to subrule (4) of this rule to ensure the accuracy and completeness of the reported information. A person or facility required to report a diagnosis pursuant to subrule (4) of this rule may elect to report the diagnosis to the state through an existing cancer registry only if the registry meets minimum reporting standards established by the department.
(3) The department shall maintain comprehensive records of all reports submitted pursuant to this rule. These reports shall be subject to the same requirements of confidentiality as provided in section 2631 of 1978 PA 368, MCL 333.2619 for data or records concerning medical research projects.
(4) The director shall provide for all of the following:
(a) A list of tumorous and precancerous disease other than cancer to be reported pursuant to subrule (2) of this rule.
(b) The quality and manner in which the cases and other information described in subrule (1) of this rule are reported to the department.
(c) The terms and conditions under which records disclosing the name and medical condition of a specific individual and kept pursuant to this rule are released by the department.
(5) This rule does not require an individual to submit to medical or department examination or supervision.
(6) The department may contract for the collection and analysis of, and research related to, the epidemiologic data required by this rule.
(7) Within 2 years after the effective date of these rules, the department shall begin evaluating the reports collected pursuant to subrule (2) of this rule. The department shall publish and make available to
the public reports summarizing the information collected. The first summary report shall be published not later than 180 days after the end of the first 2 full calendar years after the effective date of this rule. Subsequent annual summary reports shall be made on a full calendar year basis and published not later than 180 days after the end of each calendar year.
(8) Reporting pursuant to subrule (2) of this rule shall begin the next calendar year after the effective date of this rule.
R 325.9051 Definitions.
Rule 9051. (1) As used in these rules:
(a) “PRIMARY BRAIN-RELATED TUMOR” MEANS A PRIMARY TUMOR, WHETHER MALIGNANT OR BENIGN, OF THE BRAIN, MENINGES, SPINAL CORD, CAUDA EQUINA, A CRANIAL NERVE OR NERVES, OR ANY PART OF THE CENTRAL NERVOUS SYSTEM OR OF THE PITUITARY GLAND, PINEAL GLAND, OR CRANIOPHARYNGEAL GLAND.
(a)(b)"Cancer" means all diagnosis with a behavior code of 2 (carcinoma in situ) or 3 (malignant primary site) as listed in the publication entitled "International Classification of Diseases for Oncology," 1976, excluding basal, epithelial, papillary, and squamous cell carcinomas of the skin, but including carcinomas of skin of the vagina, prepuce, clitoris, vulva, labia, penis, and scrotum.(b)(c) "Department" means the department of community health.(2) The terms "clinical laboratory" and "hospital," as defined in sections 20104 and 20106, respectively, of 1978 PA 368 and MCL 333.20106 have the same meanings when used in these rules.
R 325.9052 Reportable diagnoses.
Rule 9052. (1) Cancer diagnoses, DIAGNOSES OF BENIGN BRAIN-RELATED TUMORS AND ANY TUMOROUS AND PRECANCEROUS DISEASES OTHERWISE REQUIRED TO BE
REPORTED BY STATE OR FEDERAL LAW shall be reported to the department in a manner consistent with these rules and procedures issued by the department.
(2) Diagnoses shall be reported by all hospitals and clinical laboratories.
(3) A hospital or clinical laboratory may elect to report cases through a hospital or regional cancer registry that meets the rules set by the department.
(4) Reports shall be submitted within 180 days of a diagnosis on a form prescribed or approved by the department, except for reports forwarded on electronic media.
(5) Reports submitted on electronic media shall meet data quality, format, and timeliness standards prescribed by the department.
ORR # 2003-026 DEPARTMENT OF COMMUNITY HEALTH
OFFICE OF THE STATE REGISTRAR CANCER REPORTING
Pursuant to Section 41(2) of Public Act 306 of 1969, as amended, the Department of Community Health will hold a hearing on proposed community health rules on:
Date: October 23, 2003 Location: Michigan Department of Community Health
Time: 1:00 p.m Baker-Olin West Building – Conference Room C 3423 N. Martin Luther King Jr. Boulevard Lansing, Michigan
The Proposed Rules Cover:
C R325.9051: This rule would establish tumor reporting requirements in Michigan that match those just established for the National Program of Cancer Registries within the Centers for Disease Control and Prevention.
Written comments will be accepted through October 20, 2003. Please send to the Michigan Department of Community Health, attention: Mary Greco, Legal Affairs Coordinator, at the address below.
The hearing location is handicapper accessible and interpreters will be available for the hearing impaired, if requested, seven days in advance.
These rules take effect 15 days after filing with the Secretary of State.
Michigan Department of Community Health Janet Olszewski, Director
320 S. Walnut – 6th Floor Lansing, Michigan 48913
ORR # 2003-031
DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF WORKERS’ DISABILITY COMPENSATION WORKER’S COMPENSATION HEALTH CARE SERVICES
Filed with the Secretary of State on These rules take effect on January 15, 2004
(By authority conferred on the bureau of worker's disability compensation by sections 205 and 315 of 1969 PA 317, section 33 of 1969 PA 306, Executive Reorganization Order No. 1982-2, Executive Reorganization Order No. 1986-3, and Executive Reorganization Order No. 1990-1, MCL 418.205, 418.315, 24.233, 18.24, 418.1, and 418.2)
R 418.10106, R 418.10107, R 418.10109, R 418.10202, R 418.10214, R 418.10901, R 418.101002,
R 418.101017, R 418.101022, R 418.101101 and R 418.101504 of the Administrative code are amended.
R 418.10106 Procedure codes; relative value units;
andother billing information.Rule 106. (1) Upon annual promulgation of R 418.10107, the health care services division of the bureau shall publish a manual separate from these rules containing all of the following information:
(a) All CPT® procedure codes used for billing health care services.
(b) Medicine, surgery, and radiology procedures and their associated relative value units.
(c) Hospital maximum payment ratios.
(d) Billing forms and instruction for completion.
(2) The procedure codes and standard billing and coding instructions for medicine, surgery, and radiology services shall be adopted from the most recent publication entitled “Physicians’ Current Procedural Terminology, (CPT®)” as adopted by reference in R 418.10107. However, billing and coding guidelines published in “Physicians’ Current Terminology, (CPT®)” do not guarantee reimbursement. A carrier shall only reimburse medical procedures for a work-related injury or illness that are reasonable and necessary and are consistent with accepted medical standards.
(3) The formula and methodology for determining the relative value units shall be adopted from the “Medicare RBRVS Fee Schedule” as adopted by reference in R 418.10107 using geographical information for Michigan. The geographical information, (GPCI), for these rules is a melded average using 60% of the figures published for Detroit added to 40% of the figures published for the rest of the state.
(4) The maximum allowable payment for medicine, surgery, and radiology services shall be determined by multiplying the relative value unit assigned to the procedure times the conversion factor listed in the reimbursement section, part 10 of these rules.
(5) Procedure codes from “Medicare’s National Level II Codes HCPCS” as adopted by reference in 418.10107 shall be used to describe all of the following services:
(a) Ambulance services.
(b) Medical and surgical expendable supplies.
(c) Dental procedures.
(d) Durable medical equipment.
(e) Vision and hearing services.
(f) Home health services.
(6) Both of
Tthe following medical services shall be considered “By Report” (BR):(a) All ancillary services listed in “Medicare’s National Level II CODES HCPCS”, referenced in R 418.10106.
(b) All CPT® procedure codes that do not have an assigned relative value.
R 418.10107 Source documents; adoption by reference.
Rule 107. The following documents are adopted by reference in these rules and are available for inspection at, or purchase from, the bureau of workers' and unemployment compensation, health care services division, P.O. Box 30016, Lansing, Michigan 48909, at the costs listed or from the organizations listed:
(a) "Physicians’ Current Procedural Terminology (CPT®)
20034," standard edition, copyright October20023, published by the American Medical Association, PO Box 930876, Atlanta GA, 31193-0876, order #OP054103BTFOP0541048BZA ISBN: 1-57947-420-9, 1-800-621-8335. The publication maybe purchased at a cost of
$54.95 $57.95 plus $9.95 for shipping and handling as of the time of adoption of these rules. Permission to use this publication is on file in the bureau.(b) "Medicare's National Level II Codes, HCPCS,
20034," copyright November20023, published by the American Medical Association, P.O. Box 930876 Atlanta GA 31193-0876, order #OP095103BTFOP095104BZA ISBN: 1-57947-454-3, customer service 1-800-621-8335. The publication may be purchased at a cost of $84.95, plus $11.95 for shipping and handling as of the time of adoption of these rules.(c) “Medicare RBRVS
20023: The Physicians’ Guide,” published by The American Medical Association, 515 North State Street, Chicago Il, 60610, order#OPO59602BLC3, 1-800-621-8335. The publication may be purchased at a cost of$749.95,plus$811.95 shipping and handling as of the time of adoption of these rules.(d) “Medicare RBRVS
20034: The Physicians’ Guide,” published by the American Medical Association, 515 North State Street, Chicago IL, 60610, 1-800-621-8335. The publication may be purchased at a cost of $79.95,plus $11.95 shipping and handling as of the time of adoption of these rules(e) "International Classification of Diseases, ICD-9-CM
20034 Volumes 1 & 2" copyright20023, American Medical Association, P.O. Box 930876, Atlanta GA 31193-0876, order#OP065103BTF4BZA, 1-800-621-8335. The publication may be purchased at a cost of $84.95, plus $11.95 shipping and handling as of the time of adoption of these rules.(f)
"20023 Drug Topics Red Book," published by Medical Economics Company Inc., Five Paragon Drive, Montvale, NJ 07645-1742, 1-800-678-5689. The publication may be purchased at a cost of$6472.95, plus$79.95 for shipping and handling as of the time of adoption of these rules.(g) "Michigan Uniform Billing Manual," developed in cooperation with the American Hospital Association's National Uniform Billing Committee, published by Michigan Health and Hospital Association, Attn: UB-92 Subscriptions, 6215 West St.Joseph Highway, Lansing, MI 48917, 517-886- 8366. As of the time of adoption of these rules, the cost of the publication is $160.00, plus 6% sales tax.
(h) “Relative Value Guide: A Guide For Anesthesia Values
20023,” published by the American Society of Anesthesiologists, 520 N Northwest Highway, Park Ridge, IL 60068-2573, 1-847-825-5586. As of the time of adoption of these rules, the cost of the publication, including shipping is $15.00.R 418.10109 Definitions; M to U.
Rule 109. As used in these rules:
(a) “Maximum allowable payment” means the maximum fee for a procedure that is established by these rules, a reasonable amount for a “by report” procedure, or a provider’s usual and customary charge, whichever is less.
(b) “Medical only case” means a case that does not involve wage loss compensation.
(c) “Medical rehabilitation” means, to the extent possible, the interruption, control, correction, or amelioration of a medical or a physical problem that causes incapacity through the use of appropriate treatment disciplines and modalities that are designed to achieve the highest possible level of post-injury function and a return to gainful employment.
(d) “Medically accepted standards” means a measure which is set by a competent authority as the rule for evaluating quantity or quality of health care or health care services ensuring that the health care is suitable for a particular person, condition, occasion, or place.
(e) “Morbidity” means the extent of illness, injury, or disability.
(f) “Mortality” means the likelihood of death.
(g) “New
Ppatient” means a patient who is new to the provider for a particular covered injury or illness and who needs to have medical and administrative records established.(h) “Nursing home” means a nursing care facility, including a county medical care facility, created pursuant to the provisions of
Act No. 152 of the Public Acts of 1885, as amended, being1885 PA 152,§36.1 et seq. MCLof the Michigan Compiled Laws.(i) “Orthotic equipment” means an orthopedic apparatus that is designed to support, align, prevent or correct deformities of, or improve the function of, a movable body part.
(j) “Pharmacy” means the place where the science, art, and practice of preparing, preserving, compounding, dispensing, and giving appropriate instruction in the use of drugs is practiced.
(k) “Practitioner” means an individual who is licensed, registered, or certified as defined in the Michigan public health code,
Act 368 of 19781978 PA 368, (Articles 1, 7, 15, 19, andEexcerpts from Article 5) as amended.(l) “Primary procedure” means the therapeutic procedure that is most closely related to the principal diagnosis.
(m) “Properly submitted bill” means a request by a provider for payment of health care services which is submitted to a carrier on the appropriate completed claim form with attachments as required by these rules.
(n) “Prosthesis” means an artificial substitute for a missing body part. A prosthesis is constructed by a “prosthetist”, a person who is skilled in the construction and application of a prosthesis.
(o) “Provider” means a facility, health care organization, or a practitioner.
(p) “Reasonable amount” means a payment based upon the amount generally paid in the state for a particular procedure code using data available from the provider, the carrier, or the bureau of workers’ disability compensation, health care services division.
(q) “Restorative” means that the patient’s function will demonstrate measurable improvement in a reasonable and generally predictable period of time and includes appropriate periodic care to maintain the level of function.
(r) “Secondary procedure” means a surgical procedure which is performed to ameliorate conditions that are found to exist during the performance of a primary surgery and which is considered an independent procedure that may not be performed as a part of the primary surgery or for the existing condition.
(s) “Specialist” means any of the following entities who is board-certified, board-eligible, or otherwise considered an expert in a particular field of health care by virtue of education, training, and experience generally accepted in that particular field:
(i) A doctor of chiropractic.
(ii) A doctor of dental surgery.
(iii) A doctor of medicine.
(iv) A doctor of optometry.
(v) A doctor of osteopathic medicine and surgery.
(vi) A doctor of podiatric medicine and surgery.
(t) “Subrogation” means substituting one creditor for another. An example of subrogation in workers’ compensation is when a case is determined to be workers’ compensation and the health benefits plan has already paid for the service and is requesting the workers’ compensation carrier or the provider to refund the money that the plan paid on behalf of the worker.
(u) “Technical surgical” assist
denotesmeans that additional payment for an assistant surgeon, referenced in R 418.10416 of these rules, is allowed for certain designatedthosesurgical procedureswhere payment for an assistant is allowed in addition to the primary surgeon. The Health Care Services Manual, published annually by the bureau, denotes a surgical pProcedurecodesallowing payment for theassistanttechnical surgicaleonare denoted bywith the lettera“T.”(v) “Treatment plan” means a plan of care for restorative physical treatment services that indicates the diagnosis and anticipated goals.
(w) “Usual and customary charge” means a particular provider’s average charge for a procedure to all payment sources, and includes itemized charges which were previously billed separately and which are included in the package for that procedure as defined by these rules. A usual and customary charge for a procedure shall be calculated based on data beginning January 1,
19952000.R 418.10202 Evaluation and management services.
Rule 202. (1) Procedure code 97010 performed in conjunction with an evaluation and management office visit shall not be reimbursed as a separate procedure.
(2) Minor medical and surgical supplies routinely used by the practitioner or health care organization in the office visit shall not be billed separately.
(3) Supplies, or other services, over and above those usually incidental to an office visit or other outpatient visit for the evaluation and management of a patient shall be billed separately under procedure code 99070.
(4) If an office visit is performed outside of the provider’s normal business hours, the provider may bill the add on procedure codes describing an office visit performed after hours or on Sundays or holidays. A provider may bill add on procedure code 99050 in addition to the evaluation and management service, if a service is rendered between the hours of 6:00 p.m. and 7:00 a.m., Monday through Saturday. A provider may bill add on procedure code 99054 if a service is rendered on Sundays or holidays until 7:00 a.m. of the following regular working day.
(5) A procedure that is normally part of an examination or evaluation shall not be billed independently. Range of motion shall not be reimbursed as a separate procedure in addition to the evaluation and management service unless the procedure is medically necessary and appropriate for the injured worker’s condition and diagnosis.
(6) The maximum allowable payment for the evaluation and management service shall be determined by multiplying the relative value unit, RVU, assigned to the procedure code, times the conversion factor listed in the reimbursement section of these rules.
(7) The level of an office visit or other outpatient visit for the evaluation and management of a patient is not guaranteed and may change from session to session. The level of service shall be consistent with the type of presenting complaint and supported by documentation in the record.
(8) Procedure codes 99455 and 99456 describing work-related or medical disability evaluation services shall not be used to describe an evaluation and management service for treating a work-related injury or illness. Procedure codes 99201-99350 shall be used to describe the practitioner’s medical treatment of an injured worker.
(9) The carrier shall not reimburse the provider for procedure codes 90782-90799, administration of therapeutic injections, if billed in conjunction with an evaluation and management service. The medication administered in the therapeutic injection shall be billed using procedure code 99070 and shall be identified with the national drug code number. The provider shall be reimbursed at the average wholesale price of the drug. If the provider does not bill an evaluation and management service, then the appropriate procedure code describing the administration of the drug may be billed. The administered drug is billed additionally and is payable at the average wholesale price of the drug.
(10) The provider may bill immunization procedure codes in addition to the evaluation and management procedure code. If the provider bills an immunization, then the vaccine is described with procedure codes 90476-90748, and the administration of the vaccine is described with procedure code 90471 or 90472. The carrier shall reimburse the vaccine at the average wholesale price of the vaccine plus the cost of administration billed with procedure codes 90471 or 90472. Procedure code 90471 is reimbursed at $5.00 and procedure code 90472 is reimbursed at $7.50.
(11) Procedure code 76140, x-ray consultation, shall not be paid to the provider in addition to the evaluation and management service, to review x-rays taken elsewhere. The carrier shall not pay for review of an x-ray by a practitioner other than the radiologist providing the written report or the practitioner performing the complete radiology procedure.
R 418.10214 Orthotic and prosthetic equipment.
Rule 214. (1) A copy of a prescription by one of the following is required for prosthetic and orthotic equipment:
(a) A doctor of medicine.
(b) A doctor of osteopathic medicine and surgery.
(c) A doctor of chiropractic.
(d) A doctor of podiatric medicine and surgery.
(2) Orthotic equipment may be any of the following:
(a) Custom-fit.
(b) Custom-fabricated.
(c) Non-custom supply that is prefabricated or off-the-shelf.
(3) A non-custom supply shall be billed using procedure code 99070 or A4570 for a prefabricated splint.
(4) A board-certified orthotist or prosthetist who is certified by the American board for certification in orthotics and prosthetics, incorporated shall bill orthoses and prostheses that are custom-fabricated, molded to the patient, or molded to a patient model. In addition, a doctor of podiatric medicine and surgery may bill for a custom-fabricated or custom-fit, or molded patient model foot orthosis using procedure codes L3000-L3649.
(5) L-code procedures shall include fitting and adjustment of the equipment.
(6) Maximum allowable payments for L-code procedures are listed in
Table 1510-CR 418.101504. If an L-code procedure does not have an assigned maximum allowable payment, then the procedure shall be by report, “BR.”(7) A provider may not bill more than 4 dynamic prosthetic test sockets without documentation of medical necessity. If the physician’s prescription or medical condition requires utilization of more than 4 test sockets, then a report shall be included with the bill that outlines a detailed description of the medical condition or circumstances that necessitate each additional test socket provided.
R 418.10901 General Information.
Rule 901. (1) All health care practitioners and health care organizations, as defined in these rules, shall submit charges on the proper claim form as specified in this rule. Copies of the claim forms and instruction for completion for each form shall be published separate from these rules in a manual distributed by the health care services division of the bureau. Charges shall be submitted as follows:
(a) A practitioner shall submit charges on the HCFA 1500 claim form.
(b) A doctor of dentistry shall submit charges on a standard dental claim form approved by the American dental association.
(c) A pharmacy, other than an inpatient hospital, shall submit charges on an invoice or a pharmacy universal claim form.
(d) A hospital-owned occupational, industrial clinic, or office practice shall submit charges on the HCFA 1500 claim form.
(e) A hospital billing for a practitioner service shall submit charges on a HCFA 1500 claim form.
(f) Ancillary service charges shall be submitted on the HCFA 1500 claim form for durable medical equipment and supplies, L-code procedures, ambulance, vision, and hearing services. Charges for home health services shall be submitted on the UB-92 claim form.
(g) A shoe supplier or wig supplier shall submit charges on an invoice.
(2) A provider shall submit all bills to the carrier within 1 year of the date of service for consideration of payment, except in cases of litigation or subrogation.
(3) A properly submitted bill shall include all
OFof the following appropriate documentation:(a) A copy of the medical report for the initial visit.
(b) An updated progress report if treatment exceeds 60 days.
(c) A copy of the initial evaluation and a progress report every 30 days of physical treatment, physical or occupational therapy, or manipulation services.
(d) A copy of the operative report or office report if billing surgical procedure codes 10040-69990.
(e) A copy of the anesthesia record if billing anesthesia codes 00100-01999.
(f) A copy of the radiology report if submitting a bill for a radiology service accompanied by modifier -
26. The carrier shall only reimburse the radiologist for the written report, or professional component, upon receipt of a bill for the radiology procedure.
(g) A report describing the service if submitting a bill for a “by report” procedure.
(h) A copy of the medical report if a modifier is applied to a procedure code to explain unusual billing circumstances.
R 418.101002 Conversion factors for medical, surgical, and radiology procedure codes.
Rule 1002. (1) The bureau shall determine the conversion factors for medical, surgical, and radiology procedures. The conversion factor shall be used by the bureau for determining the maximum allowable payment for medical, surgical, and radiology procedures. The maximum allowable payment shall be determined by multiplying the appropriate conversion factor times the relative value unit assigned to a procedure. The relative value units are listed for the medicine, surgical, and radiology procedure codes in a manual separate from these rules. The manual shall be published annually by the bureau using codes adopted from “Physicians’ Current Procedural Terminology (CPT®)” as referenced in
R 418.10107(a). The Bureau shall determine the relative values by using information found in the “Medicare RBRVS: The Physicians’Guide” as adopted by reference in R 418.10107(c).
(2) The conversion factor for medicine, radiology, and surgical procedures shall be
$47.0177 for the year20034 and shall be effective for dates of service on or after the effective date of these rules.R 418.101017 Reimbursement for outpatient minor medical-surgical procedures performed in
theoutpatient hospital setting when billed ontheUB-92.Rule 1017. (1) Reimbursement for services listed on Table
109242 shall be made as follows:(a) If the service occurs in the first 10 days of care beginning for a work injury, then the hospital shall be reimbursed by the ratio methodology.
(b) If the service occurs after the first 10 days, then the carrier shall reimburse the facility 60% of the maximum allowable payment for medical and surgical procedures and the technical component for radiology procedures.
(2) This rule shall not apply to services performed in a hospital-owned or hospital-system owned occupational or industrial clinic, as those services shall be considered practitioner services and shall be billed and paid as a practitioner service.
R 418.101101 Calculation and revision of payment ratio for Michigan hospitals.
Rule 1101. (1) The bureau shall annually calculate and revise, under the provisions of
Act No. 306 ofthe Public Acts of 1969, as amended, being §1969 PA 306, 24.201 et seq. MCL,of the MichiganCompiled Laws,the payment ratios for all Michigan hospitals. The calculation shall be made using a hospital’s most recent fiscal year information that is submitted to the Michigan department of community health, medical services administration, preceding each annual calculation. The information used shall be that reported to the Michigan department of community health, medical services administration, on the hospital’s statement of patient revenues and operating expenses, G2 worksheet. The bureau shall complete the payment ratio calculation between September 1 and October 1, or the earliest date when the figures are available from Michigan department of community health and shall annually publish the hospital ratio calculations in a separate manual effective for dates of service on or after the effective date of these rules.(2) The bureau shall calculate a hospital’s cost-to-charge ratio by dividing each hospital’s total operating expenses by total patient revenues as reported on the hospital’s statement of patient revenues and operating expenses, G2 worksheet.
R 418.101504 Orthotic and prosthetic codes and maximum allowable payments.
Rule 1504. The orthotic and prosthetic codes, the L-code procedures that have set fees are listed in this rule. All other L-code procedures shall be listed in Medicare’s National Level II, HCPCS as adopted by reference in R 418.10107 and shall be reimbursed as a by report procedure. The maximum allowable fees for the L-code procedures are listed in the table in this rule:
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L0120
cervical, flexible, nonadjustable (foam collar)
$17.29
L0130
cervical, flexible, thermoplastic collar, molded to patient
$117.02
L0140
cervical, semi-rigid, adjustable (plastic collar)
$42.00
L0150
cervical, semi-rigid, adjustable molded chin cup
$74.60
LO160
cervical, semi-rigid, wire frame occipital/mandibular support
$119.82
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L0170
cervical collar, molded to patient model
$796.31
L0172
cervical collar, semi-rigid, thermoplastic foam, two-piece
$110.00
L0174
cervical collar, semi-rigid, thermoplastic foam, two-piece with
$194.07
L0180
cervical, multiple post collar, occipital/mandibular supports,
$314.44
L0190
cervical, multiple post collar, occipital/mandibular supports,
$407.89
L0200
cervical, multiple post collar, occipital/mandibular supports,
$430.12
L0210
thoracic rib belt, custom fitted
$28.85
L0220
thoracic rib belt, custom fabricated
$90.00
L0300tlso,flexible (dorso-lumbar surgical support), custom fitted$124.59L0310tlso,flexible (dorso-lumbar surgical support), custom fabrica$242.46L0315tlso,flexible (dorso-lumbar surgical support), elastic type,$213.27L0317tlso,flexible (dorso-lumbar surgical support), hyperextension,$255.89L0320tlso,anterior-posterior control (taylor type), with apron$336.00L0330tlso,anterior-posterior-lateral control (knight-taylor type)$476.12L0340tlso,anterior-posterior-lateral-rotary control (arnold,$567.22L0350tlso,ant.-posterior-lateral-rotary control, flexion c$696.40L0360tlso,anterior-posterior-lateral-rotary control, flexion$1,551.72L0370tlso,ant.-posterior-lateral-rotary control, hyperextension$349.60L0380tlso,anterior-posterior-lateral-rotary control, with$614.95L0390tlso,anterior-posterior-lateral control molded to patient$1,400.30L0400tlso,ant.-posterior-lateral control molded to patient model,$1,498.32L0410tlso,ant.-posterior-lateral control, two-piece construction,$1,626.40L0420tlso,anterior-posterior-lateral control, two-piece$1,886.09L0430tlso,anterior-posterior-lateral control, with interface$1,062.50L0440tlso,ant.-posterior-lateral control, with overlapping front$899.60L0500
lso, flexible (lumbo-sacral surgical support), custom fitted
$99.00
L0510
lso, flexible (lumbo-sacral surgical support), custom
$214.00
L0515
lso, flexible (lumbo-sacral surgical support), elastic type, w/
$176.00
L0520
lso, anterior-posterior-lateral control (knight, wilcox types),
$358.03
L0530
lso, anterior-posterior control (macausland type), with apron
$359.95
L0540
lso, lumbar flexion (williams flexion type)
$387.68
L0550
lso, anterior-posterior-lateral control, molded to patient
$1,273.00
L0560
lso, ant.-posterior-lateral control, molded to patient model,
$1,590.56
L0565
lso, anterior-posterior-lateral control, custom fitted
$902.84
L0600
sacroiliac, flexible (sacroiliac surgical support), custom
$60.09
L0610
sacroiliac, flexible (sacroiliac surgical support), custom
$224.46
L0620
sacroiliac, semi-rigid, (goldthwaite, osgood types), with apron
$367.86
L0700
ctlso, ant.-posterior-lateral control, molded to patient model,
$1,779.93
L0710
ctlso, anterior-posterior-lateral-control, molded to patient
$1,882.90
L0810
halo procedure, cervical halo incorporated into jacket vest
$2,371.87
L0820
halo procedure, cervical halo incorporated into plaster body
$1,876.79
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L0830
halo procedure, cervical halo incorporated into milwaukee type
$2,829.65
L0860
addition to halo procedure, magnetic resonance image compatible
$960.00
L0900torso support, ptosis support, custom fitted$104.34L0910torsosupport, ptosis support, custom fabricated$302.09L0920torso support, pendulous abdomen support, custom fitted$110.60L0930torsosupport, pendulous abdomen support, custom fabricated$328.72L0940torso support, postsurgical support, custom fitted$103.04L0950torsosupport, postsurgical support, custom fabricated$299.10L0960
torso support, postsurgical support, pads for postsurgical
$60.01
L0970
tlso, corset front
$99.30
L0972
lso, corset front
$89.42
L0974
tlso, full corset
$155.56
L0976
lso, full corset
$138.95
L0978
axillary crutch extension
$167.24
L0980
peroneal straps, pair
$15.17
L0982
stocking supporter grips, set of four (4)
$14.15
L0984
protective body sock, each
$47.18
L1000
ctlso, inclusive of furnishing initial orthosis, including
$1,763.98
L1010
addition to ctlso or scoliosis orthosis, axilla sling
$58.31
L1020
addition to ctlso or scoliosis orthosis, kyphosis pad
$75.11
L1025
addition to ctlso or scoliosis orthosis, kyphosis pad, floating
$108.35
L1030
addition to ctlso or scoliosis orthosis, lumbar bolster pad
$55.27
L1040
addition to ctlso or scoliosis orthosis, lumbar or lumbar rib
$67.79
L1050
addition to ctlso or scoliosis orthosis, sternal pad
$72.34
L1060
addition to ctlso or scoliosis orthosis, thoracic pad
$83.09
L1070
addition to ctlso or scoliosis orthosis, trapezius sling
$78.18
L1080
addition to ctlso or scoliosis orthosis, outrigger
$48.08
L1085
addition to ctlso or scoliosis orthosis, outrigger, bilateral
$133.74
L1090
addition to ctlso or scoliosis orthosis, lumbar sling
$79.64
L1100
addition to ctlso or scoliosis orthosis, ring flange, plastic
$138.17
L1110
addition to ctlso or scoliosis orthosis, ring flange, plastic
$221.90
L1120
addition to ctlso, scoliosis orthosis, cover for upright, each
$34.51
L1200
tlso, inclusive of furnishing initial orthosis only
$1,424.25
L1210
addition to tlso (low profile), lateral thoracic extension
$227.34
L1220
addition to tlso (low profile), anterior thoracic extension
$192.48
L1230
addition to tlso (low profile), milwaukee type superstructure
$493.91
L1240
addition to tlso (low profile), lumbar derotation pad
$67.46
L1250
addition to tlso (low profile), anterior asis pad
$62.77
L1260
addition to tlso (low profile), anterior thoracic derotation
$65.74
L1270
addition to tlso (low profile), abdominal pad
$67.32
L1280
addition to tlso (low profile), rib gusset (elastic), each
$74.95
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L1290
addition to tlso (low profile), lateral trochanteric pad
$68.29
L1300
other scoliosis procedure, body jacket molded to patient model
$1,451.36
L1310
other scoliosis procedure, postoperative body jacket
$1,493.46
L1499
spinal orthosis, not otherwise classisfied
BR
L1500
thkao, mobility frame (newington, parapodium types)
$1,650.36
L1510
thkao, standing frame
$828.93
L1520
thkao, swivel walker
$1,486.64
L1685
ho, abduction control of hip joint, postop. Hip abduction
$1,033.49
L1686
ho, abduction control of hip joint, postop. Hip abduction type,
$653.04
L1800
ko, elastic with stays, prefabricated, includes fitting and
$43.34
L1810
ko, elastic with joints, prefabricated, includes fitting and
$81.00
L1815
ko, elastic or other elastic type material with condylar pad(s)
$63.13
L1820
ko, elastic or other elastic type material with condylar pads
$103.00
L1825
ko, elastic knee cap, prefabricated
$35.83
L1830
ko, immobilizer, canvas longitudinal, prefabricated
$57.01
L1832
ko, adjustable knee joints, positional orthosis, rigid support,
$480.05
L1834
ko, without knee joint, rigid, custom fabricated
$674.46
L1840
ko, derotation, medial-lateral, anterior cruciate ligament,
$798.89
L1844
ko, single upright, thigh and calf, with adjustable flexion and
$734.88
L1845
ko, double upright, thigh and calf, with adjustable flexion and
$583.78
L1846
ko, double upright, thigh and calf, with adjustable flexion and
$985.10
L1850
ko, swedish type, prefabricated
$187.57
L1855
ko, molded plastic, thigh and calf sections, with double
$954.77
L1858
ko, molded plastic, polycentric knee joints, pneumatic knee
$1,221.93
L1860
ko, modification of supracondylar prosthetic socket, custom
$1,383.48
L1870
ko, double upright, thigh and calf lacers, with knee joints,
$909.28
L1880
ko, double upright, nonmolded thigh and calf cuffs/lacers with
$550.82
L1900
afo, spring wire, dorsiflexion assist calf band, custom
$234.40
L1902
afo, ankle gauntlet, prefabricated, includes fitting and
$52.02
L1904
afo, molded ankle guantlet, custom fabricated
$333.00
L1906
afo, multi-ligamentus ankle support, prefabricated
$86.17
L1910
afo, posterior, single bar, clasp attachment to shoe counter,
$174.27
L1920
afo, single upright with static or adjustable stop (phelps or
$286.29
L1930
afo, plastic, prefabricated
$175.57
L1940
afo, plastic, custom fabricated
$429.68
L1945
afo, molded to patient model, plastic, rigid anterior tibial
$1,145.70
L1950
afo, spiral, (irm type), plastic, custom fabricated
$647.18
L1960
afo, posterior solid ankle, plastic, custom fabricated
$530.36
L1970
afo, plastic, with ankle joint, custom fabricated
$618.24
L1980
afo, single upright free plantar dorsiflexion, solid stirrup,
$318.88
L1990
afo, double upright free plantar dorsiflexion, solid stirrup,
$459.09
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L2000
kafo, single upright, free knee, free ankle, solid stirrup,
$881.27
L2010
kafo, single upright, free ankle, solid stirrup, thigh and calf
$803.35
L2020
kafo, double upright, free knee, free ankle, solid stirrup,
$1,132.33
L2030
kafo, double upright, free ankle, solid stirrup, thigh and calf
$880.19
L2036
kafo, full plastic, double upright, free knee, custom
$2,022.35
L2037
kafo, full plastic, single upright, free knee, custom
$1,447.16
L2038
kafo, full plastic, without knee joint, multiaxis ankle, custom
$1,024.83
L2040
hkafo, torsion control, bilateral rotation straps, pelvic
$154.26
L2050
hkafo, torsion control, bilateral torsion cables, hip joint,
$413.88
L2060
hkafo, torsion control, bilateral torsion cables, ball bearing
$504.44
L2070
hkafo, torsion control, unilateral rotation straps, pelvic
$116.84
L2080
hkafo, torsion control, unilateral torsion cable, hip joint,
$312.50
L2090
hkafo, torsion control, unilateral torsion cable, ball bearing
$380.99
L2102
afo, fracture orthosis, tibial fracture cast orthosis, plaster
$521.09
L2104
afo, fracture orthosis, tibial fracture cast orthosis,
$619.81
L2106
afo, fracture orthosis, tibial fracture cast orthosis,
$747.33
L2108
afo, fracture orthosis, tibial fracture cast orthosis, custom
$1,170.03
L2112
afo, fracture orthosis, tibial fracture orthosis, soft,
$304.03
L2114
afo, fracture orthosis, tibial fracture orthosis, semi-rigid,
$440.38
L2116
afo, fracture orthosis, tibial fracture orthosis, rigid,
$537.16
L2122
kafo, fracture orthosis, femoral fracture cast orthosis,
$891.10
L2124
kafo, fracture orthosis, femoral fracture cast orthosis,
$992.94
L2126
kafo, fracture orthosis, femoral fracture cast orthosis,
$1,356.79
L2128
kafo, fracture orthosis, femoral fracture cast orthosis, custom
$1,498.50
L2132
kafo, fracture orthosis, femoral fracture cast orthosis, soft,
$525.66
L2134
kafo, fracture orthosis, femoral fracture cast orthosis, semi-
$803.12
L2136
kafo, fracture orthosis, femoral fracture cast orthosis, rigid
$878.87
L2180
addition to lower extremity fracture orthosis, plastic shoe
$101.75
L2182
addition to lower extremity fracture orthosis, drop lock knee
$79.63
L2184
addition to lower extremity fracture orthosis, limited motion
$107.63
L2186
add. To lower extremity fracture orthosis, adjustable motion
$130.80
L2188
addition to lower extremity fracture orthosis, quadrilateral
$260.22
L2190
addition to lower extremity fracture orthosis, waist belt
$59.45
L2192
addition to lower extremity fracture orthosis, hip joint,
$309.80
L2200
addition to lower extremity, limited ankle motion, each joint
$41.30
L2210
addition to lower extremity, dorsiflexion assist (plantar
$58.40
L2220
add. To lower extremity, dorsiflexion and plantar flexion
$71.16
L2230
addition to lower extremity, split flat caliper stirrups and
$66.67
L2240
addition to lower extremity, round caliper and plate attachment
$72.66
L2250
add. To lower extremity, foot plate, molded to patient model,
$308.74
L2260
addition to lower extremity, reinforced solid stirrup (scott-
$174.17
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L2265
addition to lower extremity, long tongue stirrup
$102.31
L2270
addition to lower extremity, varus/valgus correction ("t")
$46.67
L2275
add. To lower extremity, varus/valgus correction, plastic
$103.91
L2280
addition to lower extremity, molded inner boot
$393.43
L2300
addition to lower extremity, abduction bar (bilateral hip
$233.93
L2310
addition to lower extremity, abduction bar, straight
$106.88
L2320
addition to lower extremity, nonmolded lacer
$178.76
L2330
addition to lower extremity, lacer molded to patient model
$341.16
L2335
addition to lower extremity, anterior swing band
$197.38
L2340
addition to lower extremity, pre-tibial shell, molded to
$388.32
L2350
add. To lower extremity, prosthetic type, (bk) socket, molded
$774.19
L2360
addition to lower extremity, extended steel shank
$44.96
L2370
addition to lower extremity, patten bottom
$223.04
L2375
addition to lower extremity, torsion control, ankle joint and
$99.17
L2380
addition to lower extremity, torsion control, straight knee
$106.97
L2385
addition to lower extremity, straight knee joint, heavy duty,
$116.38
L2390
addition to lower extremity, offset knee joint, each joint
$95.11
L2395
addition to lower extremity, offset knee joint, heavy duty,
$101.95
L2397
addition to lower extremity orthosis, suspension sleeve
$87.81
L2405
addition to knee joint, drop lock, each joint
$44.22
L2415
addition to knee joint, cam lock (swiss, french, bail types),
$159.56
L2425
addition to knee joint, disc or dial lock for adjustable knee
$158.17
L2435
addition to knee joint, polycentric joint, each joint
$143.80
L2492
addition to knee joint, lift loop for drop lock ring
$88.60
L2500
add. To lower extremity, thigh/weight bearing, gluteal/ischial
$274.10
L2510
addition to lower extremity, thigh/weight bearing, quadri-
$631.12
L2520
add. To lower extremity, thigh/weight bearing, quadri-lateral
$374.57
L2525
addition to lower extremity, thigh/weight bearing, ischial
$873.78
L2526
addition to lower extremity, thigh/weight bearing, ischial
$595.12
L2530
addition to lower extremity, thigh/weight bearing, lacer,
$204.14
L2540
addition to lower extremity, thigh/weight bearing, lacer,
$367.33
L2550
addition to lower extremity, thigh/weight bearing, high roll
$249.53
L2570
addition to lower extremity, pelvic control, hip joint, clevis
$413.84
L2580
addition to lower extremity, pelvic control, pelvic sling
$403.24
L2600
addition to lower extremity, pelvic control, hip joint, clevis
$178.44
L2610
addition to lower extremity, pelvic control, hip joint, clevis,
$211.00
L2620
addition to lower extremity, pelvic control, hip joint, heavy-
$232.31
L2622
addition to lower extremity, pelvic control, hip joint,
$266.44
L2624
addition to lower extremity, pelvic control, hip joint,
$287.71
L2627
addition to lower extremity, pelvic control, plastic, molded to
$1,489.46
L2628
addition to lower extremity, pelvic control, metal frame,
$1,455.67
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L2630
addition to lower extremity, pelvic control, band and belt,
$215.15
L2640
addition to lower extremity, pelvic control, band and belt,
$291.98
L2650
addition to lower extremity, pelvic and thoracic control,
$104.27
L2660
addition to lower extremity, thoracic control, thoracic band
$161.94
L2670
addition to lower extremity, thoracic control, paraspinal
$148.21
L2680
addition to lower extremity, thoracic control, lateral support
$135.96
L2750
addition to lower extremity orthosis, plating chrome or nickel,
$72.62
L2760
addition to lower extremity orthosis, extension, per extension,
$52.79
L2770
addition to lower extremity orthosis, any material, per bar or
$53.64
L2780
addition to lower extremity orthosis, non-corrosive finish, per
$58.80
L2785
addition to lower extremity orthosis, drop lock retainer, each
$27.54
L2795
addition to lower extremity orthosis, knee control, full
$57.13
L2800
addition to lower extremity orthosis, knee control, kneecap,
$92.00
L2810
addition to lower extremity orthosis, knee control, condylar
$67.86
L2820
addition to lower extremity orthosis, soft interface for molded
$75.46
L2830
addition to lower extremity orthosis, soft interface for molded
$81.62
L2840
addition to lower extremity orthosis, tibial length sock,
$30.06
L2850
addition to lower extremity orthosis, femoral length sock,
$42.15
L2999
unlisted procedures for lower extremity orthoses
BR
L3000
foot insert, removable, molded to patient model, "ucb" type,
$170.00
L3001
foot insert, removable, molded to patient model, spenco, each
BR
L3002
foot insert, removable, molded to patient model, plastazote or
$99.00
L3003
foot insert, removable, molded to patient model, silicone gel,
$99.00
L3010
foot insert, removable, molded to patient model, longitudinal
$135.00
L3020
foot insert, removable, molded to patient model,
$99.00
L3030
foot insert, removable, formed to patient foot, each
BR
L3040
foot, arch support, removable, premolded, longitudinal, each
BR
L3050
foot, arch support, removable, premolded, metatarsal, each
BR
L3060
foot, arch support, removable, premolded,
BR
L3070
foot, arch support, nonremovable, attached to shoe,
BR
L3080
foot, arch support, nonremovable, attached to shoe, metatarsal,
BR
L3090
foot, arch support, nonremovable, attached to shoe, longitudin
BR
L3100
hallus-valgus night dynamic splint
BR
L3150
foot, abduction rotation bar, without shoes
BR
L3215
orthopedic footwear, woman's shoes, oxford
$94.18
L3216
orthopedic footwear, woman's shoes, depth inlay
$108.00
L3217
orthopedic footwear, woman's shoes, hightop, depth inlay
$127.00
L3218orthopedicfootwear, woman's surgical boot, each$87.00L3219
orthopedic footwear, man's shoes, oxford
$102.87
L3221
orthopedic footwear, man's shoes, depth inlay
$120.00
L3222
orthopedic footwear, man's shoes, hightop, depth inlay
$150.00
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L3223orthopedicfootwear, man's surgical boot, each$91.00L3230
orthopedic footwear, custom shoes, depth inlay
$425.00
L3250
orthopedic footwear, custom molded shoe, removable inner mold,
$381.00
L3251
foot, shoe molded to patient model, silicone shoe, each
$450.00
L3252
foot, shoe molded to patient model, plastazote (or similar),
$300.00
L3253
foot, molded shoe plastazote (or similar), custom fitted, each
$90.00
L3254
nonstandard size or width
$38.00
L3257
orthopedic footwear, additional charge for split size
$180.00
L3260
ambulatory surgical boot, each
$60.00
L3265
plastazote sandal, each
$35.00
L3300
lift, elevation, heel, tapered to metatarsals, per inch
$42.00
L3310
lift, elevation, heel and sole, neoprene, per inch
$40.00
L3320
lift, elevation, heel and sole, cork, per inch
BR
L3330
lift, elevation, metal extension (skate)
$275.00
L3332
lift, elevation, inside shoe, tapered, up to one-half inch
$18.00
L3334
lift, elevation, heel, per inch
$25.00
L3340
heel wedge, sach
$70.00
L3350
heel wedge
$13.00
L3360
sole wedge, outside sole
$15.00
L3370
sole wedge, between sole
$22.00
L3380
clubfoot wedge
$32.00
L3390
outflare wedge
$15.00
L3400
metatarsal bar wedge, rocker
$56.00
L3410
metatarsal bar wedge, between sole
$64.00
L3420
full sole and heel wedge, between sole
$32.00
L3430
heel, counter, plastic reinforced
$44.00
L3440
heel, counter, leather reinforced
$35.00
L3500
miscellaneous shoe addition, insole, leather
BR
L3510
miscellaneous shoe addition, insole, rubber
BR
L3520
miscellaneous shoe addition, insole, felt covered with leather
BR
L3530
miscellaneous shoe addition, sole, half
BR
L3540
miscellaneous shoe addition, sole, full
BR
L3550
miscellaneous shoe addition, toe tap, standard
BR
L3560
miscellaneous shoe addition, toe tap, horseshoe
BR
L3570
miscellaneous shoe addition, special extension to instep
BR
L3580
miscellaneous shoe addition, convert instep to velcro closure
BR
L3590
miscellaneous shoe addition, convert firm shoe counter to soft
BR
L3595
miscellaneous shoe addition, march bar
BR
L3650
so, figure of eight design abduction restrainer
$37.82
L3660
so, figure of eight design abduction restrainer, canvas and
$65.54
L3670
so, acromio/clavicular (canvas and webbing type)
$72.11
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L3700
eo, elastic with stays
$44.51
L3710
eo, elastic with metal joints
$78.83
L3720
eo, double upright with forearm/arm cuffs, free motion
$556.10
L3730
eo, double upright with forearm/arm cuffs, extension/flexion
$766.44
L3740
eo, double upright with forearm/arm cuffs, adjustable position
$908.66
L3800
whfo, short opponens, no attachments
$140.00
L3805
whfo, long opponens, no attachment
$256.00
L3810
whfo, addition to short and long opponens, thumb abduction
$55.09
L3815
whfo, addition to short and long opponens, second m.p.
$51.16
L3820
whfo, addition to short and long opponens, i.p. extension
$87.86
L3825
whfo, addition to short and long opponens, m.p. extension stop
$55.14
L3830
whfo, addition to short and long opponens, m.p. extension
$71.98
L3835
whfo, addition to short and long opponens, m.p. spring
$78.02
L3840
whfo, addition to short and long opponens, spring swivel thumb
$53.45
L3845
whfo, addition to short and long opponens, thumb i.p. extension
$69.02
L3850
whfo, addition to short and long opponens, action wrist, with
$98.59
L3855
whfo, addition to short and long opponens, adjustable m.p.
$99.38
L3860
whfo, add. To short and long opponens, adjustable m.p. flexion
$136.03
L3900
whfo, dynamic flexor hinge, reciprocal wrist extension/flexion,
$1,396.48
L3901
whfo, dynamic flexor hinge, reciprocal wrist extension/flexion,
$1,481.20
L3902
whfo, external powered, compressed gas
$2,137.19
L3904
whfo, external powered, electric
$2,354.94
L3906
whfo, wrist gauntlet, custom fabricated
$384.00
L3907
whfo, wrist gauntlet with thumb spica, custom fabricated
$406.00
L3908
whfo, wrist extension control cock-up, prefabricated
$38.21
L3910
whfo, swanson design
$253.61
L3912
whfo, flexion glove with elastic finger control
$69.00
L3914
whfo, wrist extension cock-up, prefabricated
$62.00
L3916
whfo, wrist extension cock-up, with outrigger, prefabricated
$109.00
L3918
whfo, knuckle bender, prefabricated
$64.00
L3920
whfo, knuckle bender, with outrigger, prefabricated
$90.00
L3922
whfo, knuckle bender, two segment to flex joints, prefabricated
$75.02
L3924
whfo, oppenheimer, prefabricated
$88.95
L3926
whfo, thomas suspension, prefabricated
$71.96
L3928
whfo, finger extension, with clock spring, prefabricated
$43.89
L3930
whfo, finger extension, with wrist support, prefabricated
$50.94
L3932
whfo, safety pin, spring wire, prefabricated
$38.12
L3934
whfo, safety pin, modified, prefabricated
$40.91
L3936
whfo, palmer, prefabricated
$75.73
L3938
whfo, dorsal wrist, prefabricated
$74.25
L3940
whfo, dorsal wrist, with outrigger attachment, prefabricated
$83.41
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L3942
whfo, reverse knuckle bender, prefabricated
$62.14
L3944
whfo, reverse knuckle bender, with outrigger, prefabricated
$78.52
L3946
whfo, composite elastic, prefabricated
$59.28
L3948
whfo, finger knuckle bender, prefabricated
$46.85
L3950
whfo, combination oppenheimer, with knuckle bender and two
$126.68
L3952
whfo, combination oppenheimer, with reverse knuckle and two
$141.50
L3954
whfo, spreading hand, prefabricated
$77.63
L3960
sewho, abduction positioning, airplane design, prefabricated
$505.85
L3962
sewho, abduction positioning, erbs palsy design, prefabricated
$457.52
L3963
sewho, molded shoulder, arm, forearm, and wrist with
$1,063.83
L3964
seo, mobile arm support attached to wheelchair, balanced, adj.
$501.52
L3965
seo, mobile arm support attached to wheelchair, balanced, adj.
$772.40
L3966
seo, mobile arm support attached to wheelchair, balanced,
$613.07
L3968
seo, mobile arm support attached to wheelchair, balanced and,
$713.05
L3969
seo, mobile arm support, monosuspension arm and hand support,
$563.81
L3970
seo, addition to mobile arm support, elevating proximal arm
$193.93
L3972
seo, addition to mobile arm support, offset or lateral rocker
$178.22
L3974
seo, addition to mobile arm support, supinator
$109.98
L3980
upper extremity fracture orthosis, humeral, prefabricated
$197.13
L3982
upper extremity fracture orthosis, radius/ulnar, prefabricated
$238.05
L3984
upper extremity fracture orthosis, wrist, prefabricated
$219.47
L3985
upper extrem.fracture orthosis, forearm, hand with wrist hinge,
$496.93
L3986
upper extremity fracture orthosis, combination of humeral,
$476.56
L3995
addition to upper extremity orthosis, sock, fracture or equal,
$20.85
L3999
upper limb orthosis, not otherwise specified
BR
L4000
replace girdle for milwaukee orthosis
$1,107.83
L4010
replace trilateral socket brim
$942.50
L4020
replace quadrilateral socket brim, molded to patient model
$748.37
L4030
replace quadrilateral socket brim, custom fitted
$438.67
L4040
replace molded thigh lacer
$354.66
L4045
replace nonmolded thigh lacer
$285.01
L4050
replace molded calf lacer
$358.70
L4055
replace nonmolded calf lacer
$232.27
L4060
replace high roll cuff
$276.12
L4070
replace proximal and distal upright for kafo
$244.52
L4080
replace metal bands kafo, proximal thigh
$87.00
L4090
replace metal bands kafofo, calf or distal thigh
$78.46
L4100
replace leather cuff kafo, proximal thigh
$90.62
L4110
replace leather cuff kafofo, calf or distal thigh
$73.68
L4130
replace pretibial shell
$431.00
L4210
repair of orthotic device, repair or replace minor parts
BR
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L4350
pneumatic ankle control splint (e.g., aircast), prefabricated
$58.25
L4360
pneumatic walking splint (e.g., aircast), prefabricated
$180.43
L4370
pneumatic full leg splint (e.g., aircast), prefabricated
$123.02
L4380
pneumatic knee splint (e.g., aircast), prefabricated
$69.99
L5000
partial foot, shoe insert with longitudinal arch, toe filler
$400.00
L5010
partial foot, molded socket, ankle height, with toe filler
$1,217.00
L5020
partial foot, molded socket, tibial tubercle height, with toe
$2,226.00
L5050
ankle, symes, molded socket, sach foot
$2,231.00
L5060
ankle, symes, metal frame, molded leather socket, articulated
$2,691.00
L5100
below knee, molded socket, shin, sach foot
$2,499.00
L5105
below knee, plastic socket, joints and thigh lacer, sach foot
$3,215.69
L5150
knee disarticulation (or through knee), molded socket, external
$3,599.00
L5160
knee disarticulation, (or through knee), molded socket, bent,
$3,869.00
L5200
above knee, molded socket, single axis constant friction knee,
$3,081.00
L5210
above knee, short prosthesis, no knee joint ("stubbies"), with,
$2,332.00
L5220
above knee, short prosthesis, no knee joint ("stubbies"),
$2,592.00
L5230
above knee, for proximal femoral focal deficiency, constant
$4,198.00
L5250
hip dis-articulation, canadian type; molded socket, hip joint,
$4,802.00
L5270
hip dis-articulation, tilt table type, molded socket, locking
$4,760.75
L5280
hemipelvectomy, canadian type; molded socket, hip joint, single
$4,713.13
L5301
below knee, molded socket, shin, sach foot, endoskeletal system
$2,612.75
L5311
knee disarticulation, molded socket, enternal knee joints, shin
$3,859.00
L5321
above knee, molded socket, open end, sach foot, endoskeletal,
$3,815.00
L5331
hip disarticlation, canadian type, molded socket, endoskeletal
$5,450.14
L5341
hemipelvectomy, canadian type, molded socket, endoskeletal, hip
$5,823.31
L5400
immediate post-surgical or early fitting, application of
$1,261.00
L5410
immediate post-surgical or early fitting, application of
$333.00
L5420
immediate post-surgical or early fitting, application of
$1,547.71
L5430
immediate post-surgical or early fitting, application of
$420.12
L5450
immediate post-surgical or early fitting, application of non-
$363.27
L5460
immediate post-surgical or early fitting, application of non-
$476.46
L5500
initial below knee "ptb" type socket, "usmc" or equal pylon, no
$1,262.00
L5505
initial, above knee-knee dis-articulation, ischial level
$1,685.00
L5510
preparatory, below knee "ptb" type socket, sach foot, plaster
$1,535.00
L5520
preparatory, below knee "ptb" type socket, sach foot,
$1,347.00
L5530
preparatory, below knee "ptb" type socket, no cover, sach foot,
$1,752.00
L5535
preparatory, below knee "ptb" type socket, no cover, sach foot,
$1,569.73
L5540
preparatory, below knee "ptb" type socket, no cover, sach foot,
$1,765.00
L5560preparatory,above knee-knee disarticulation, ischial$1,829.00L5570
preparatory, above knee-knee disarticulation, ischial
$1,840.00
L5580
preparatory, above knee-knee disarticulation, ischial
$2,352.00
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L5585
preparatory, above knee-knee disarticulation, ischial
$2,696.00
L5590
preparatory, above knee-knee disarticulation, ischial
$2,225.22
L5595
preparatory, hip disarticulation-hemipelvectomy, pylo
$3,727.16
L5600
preparatory, hip disarticulation-hemipelvectomy, pylon,
$4,115.89
L5610
addition to lower extremity, endoskeletal above
$1,916.47
L5611
addition to lower extremity, endoskeletal system above
$1,491.40
L5613
addition to lower extremity, endoskeletal above, 4ar lin
$2,268.50
L5614
addition to lower extremity, above knee--knee disarticula
$3,508.49
L5616
addition to lower extremity, above knee, universal mult
$1,257.18
L5618
addition to lower extremity, test socket, symes
$654.32
L5620
addition to lower extremity, test socket, below knee
$533.41
L5622
addition to lower extremity, test socket, knee disarticulation
$729.81
L5624
addition to lower extremity, test socket, above knee
$635.07
L5626
addition to lower extremity, test socket, hip disarticulation
$777.71
L5628
addition to lower extremity, test socket, hemipelvectomy
$775.86
L5629
addition to lower extremity, below knee, acrylic socket
$220.64
L5630
addition to lower extremity, symes type, expandable wall socket
$415.43
L5631
addition to lower extremity, above knee or
$305.04
L5632
addition to lower extremity, symes type, "ptb" brim d
$205.52
L5634
addition to lower extremity, symes type, posterior opening
$281.57
L5636
addition to lower extremity, symes type, medial opening socket
$235.86
L5637
addition to lower extremity, below knee, total contact
$294.15
L5638
addition to lower extremity, below knee, leather socket
$450.48
L5639
addition to lower extremity, below knee, wood socket
$1,037.83
L5640
addition to lower extremity, knee disarticulation, leather
$591.89
L5642
addition to lower extremity, above knee, leather socket
$573.50
L5643
addition to lower extremity, hip disarticulation, flexible
$1,440.73
L5644
addition to lower extremity, above knee, wood socket
$546.73
L5645
addition to lower extremity, below knee, flexible inner socket,
$748.26
L5646
addition to lower extremity, below knee, air cushion socket
$507.18
L5647
addition to lower extremity, below knee, suction socket
$736.32
L5648
addition to lower extremity, above knee, air cushion socket
$609.43
L5649
addition to lower extremity, ischial containment/narrow m-l
$1,882.67
L5650
addition to lower extremity, total contact, above knee or knee
$451.88
L5651
addition to lower extremity, above knee, flexible inner socket,
$1,111.63
L5652
addition to lower extremity, suction suspension, above knee or
$606.28
L5653
addition to lower extremity, knee disarticulation, expandable
$661.74
L5654
addition to lower extremity, socket insert, symes (kemblo,
$426.49
L5655
addition to lower extremity, socket insert, below knee (kemblo,
$348.15
L5656
addition to lower extremity, socket insert, knee
$343.38
L5658
addition to lower extremity, socket insert, above knee (kemblo,
$336.56
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L5660
addition to lower extremity, socket inset, symes, silicone gel
$533.65
L5661
addition to lower extremity, socket insert, multidurometer,
$563.29
L5662
addition to lower extremity, socket insert, below knee,
$489.35
L5663
addition to lower extremity, socket insert, knee
$637.86
L5664
addition to lower extremity, socket insert, above knee,
$614.54
L5665
addition to lower extremity, socket insert, multidurometer,
$473.96
L5666
addition to lower extremity, below knee, cuff suspension
$64.80
L5668
addition to lower extremity, below knee, molded distal cushion
$93.48
L5670
addition to lower extremity, below knee, molded supracondylar
$300.76
L5672
addition to lower extremity, below knee, removable medial brim
$276.02
L5674
addition to lower extremity, below knee, latex sleeve
$48.81
L5675
addition to lower extremity, below knee, latex sleeve
$66.16
L5676
addition to lower extremity, below knee, knee joints, single
$335.44
L5677
addition to lower extremity, below knee, knee joints,
$456.40
L5678
addition to lower extremity, below knee, joint covers, pair
$30.33
L5680
addition to lower extremity, below knee, thigh lacer, nonmolded
$281.74
L5682
addition to lower extremity, below knee, thigh lacer,
$578.90
L5684
addition to lower extremity, below knee, fork strap
$44.54
L5686
addition to lower extremity, below knee, back check (extension
$47.29
L5688
addition to lower extremity, below knee, waist belt, webbing
$56.53
L5690
addition to lower extremity, below knee, waist belt, padded and
$90.58
L5692
addition to lower extremity, above knee, pelvic control belt,
$123.00
L5694
addition to lower extremity, above knee, pelvic control belt,
$167.93
L5695
addition to lower extremity, above knee, pelvic control, sleeve
$150.96
L5696
addition to lower extremity, above knee or knee
$171.28
L5697
addition to lower extremity, above knee or knee
$74.32
L5698
addition to lower extremity, above knee or knee
$96.56
L5699
all lower extremity prostheses, shoulder harness
$142.40
L5700
replacement, socket, below knee, molded to patient model
$2,534.95
L5701
replacement, socket, above knee/knee disarticulation including
$3,147.36
L5702
replacement, socket, hip disarticulation, including hip joint,
$4,021.66
L5704
replacement, custom shaped protective cover, below knee
$436.72
L5705
replacement, custom shaped protective cover, above knee
$800.64
L5706
replacement, custom shaped protective cover, knee
$780.94
L5707
replacement, custom shaped protective cover, hip
$1,049.19
L5710
addition, exoskeletal knee-shin system, single axis, manual
$332.93
L5711
addition, exoskeletal knee-shin system, single axis, manual lo
$483.34
L5712
addition, exoskeletal knee-shin system, single axis, friction
$398.87
L5714
addition, exoskeletal knee-shin system, single axis, variable
$387.18
L5716
addition, exoskeletal knee-shin system, polycentric mechanical
$674.65
L5718
addition, exoskeletal knee-shin system, polycentric, friction c
$843.24
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L5722
addition, exoskeletal knee-shin system, single axis, pneumatic
$835.75
L5724
addition, exoskeletal knee-shin system, single axis, fluid
$1,397.20
L5726
addition, exoskeletal knee-shin system, single axis, external
$1,610.24
L5728
addition, exoskeletal knee-shin system, single axis, fluid
$1,851.35
L5780
addition, exoskeletal knee-shin system, single axis,
$1,059.79
L5785
addition, exoskeletal system, below knee, ultra-light material
$480.92
L5790
addition, exoskeletal system, above knee, ultra-light material
$665.57
L5795
addition, exoskeletal system, hip disarticulation, ultra-light
$993.86
L5810
addition, endoskeletal knee-shin system, single axis, manual
$450.67
L5811
addition, endoskeletal knee-shin system, single axis, manual
$675.10
L5812
addition, endoskeletal knee-shin system, single axis friction
$495.00
L5816
addition, endoskeletal knee-shin system, polycentric mechanical
$710.00
L5818
addition, endoskeletal knee-shin system, polycentric, friction
$888.94
L5822
addition, endoskeletal knee-shin system, single axis, pneumatic
$1,576.30
L5824
addition, endoskeletal knee-shin system, single axis, fluid
$1,400.00
L5828
addition, endoskeletal knee-shin system, single axis, fluid
$2,263.39
L5830
addition, endoskeletal knee-shin system, single axis,
$1,756.46
L5840
addition, endoskeletal knee-shin system, single axis,
$1,980.00
L5850
addition, endoskeletal system, above knee or hip
$118.42
L5855
addition, endoskeletal system, hip disarticulation, mechanical
$285.88
L5910
addition, endoskeletal system, below knee, alignable system
$335.26
L5920
addition, endoskeletal system, above knee or hip
$491.14
L5925
addition, endoskeletal system, above knee, knee disarticulation
$280.00
L5940
addition, endoskeletal system, below knee, ultra-light material
$464.30
L5950
addition, endoskeletal system, above knee, ultra-light material
$720.17
L5960
addition, endoskeletal system, hip disarticulation, ultra-light
$892.37
L5962
addition, endoskeletal system, below knee, flexible protective
$490.00
L5964
addition, endoskeletal system, above knee, flexible protective
$798.56
L5966
addition endoskeletal system, hip disarticulation, flexible
$1,035.31
L5970
all lower extremity prostheses, foot, external keel, sach foot
$187.99
L5972
all lower extremity prostheses, flexible keel foot (safe, sten,
$326.23
L5974
all lower extremity prostheses, foot, single axis ankle/foot
$215.70
L5976
all lower extremity prostheses, energy storing foot (seattl
$451.39
L5978
all lower extremity prostheses, foot, multixial ankle/foot
$270.13
L5979
all lower extremity prostheses, multixial ankle/foot, dynami
$2,090.00
L5980
all lower extremity prostheses, flex-foot system
$2,917.79
L5981
all lower extremity prostheses, flex-walk system or equal
$2,382.65
L5982
all exoskeletal lower extremity prostheses, axial rotation unit
$535.13
L5984
all endoskeletal lower extremity prostheses, axial rotatio
$527.33
L5986
all lower extremity prostheses, multixial rotation unit ("mcp
$586.57
L5999
lower extremity prosthesis, not otherwise classified
BR
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L6000
partial hand, robinids, thumb remaining (or equal)
$1,229.90
L6010
partial hand, robinids, little and/or ring finger remaining
$1,368.70
L6020
partial hand, robon aids, no finger remaining (or equal)
$1,276.09
L6050
wrist disarticulation, molded socket, flexible elbow hinges
$2,263.00
L6055
wrist disarticulation, molded socket with expandable interface,
$2,450.75
L6100
below elbow, molded socket, flexible elbow hinge, triceps pad
$2,229.00
L6110
below elbow, molded socket (muenster or northwestern suspension
$2,284.04
L6120
below elbow, molded double wall split socket, step-up hinges,
$2,202.07
L6130
below elbow, molded double wall split socket, stump activated
$2,396.27
L6200
elbow disarticulation, molded socket, outside locking hinge,
$2,982.00
L6205
elbow disarticulation, molded socket with expandable interface,
$3,370.85
L6250
above elbow, molded double wall socket, internal locking elbow,
$3,267.79
L6300
shoulder disarticulation, molded socket, shoulder bulkhead,
$3,448.64
L6310
shoulder disarticulation, passive restoration (complete
$2,809.00
L6320
shoulder disarticulation, passive restoration (shoulder cap
$1,581.89
L6350
interscapular thoracic, molded socket, shoulder bulkhead,
$3,625.73
L6360
interscapular thoracic, passive restoration (complete
$2,948.39
L6370
interscapular thoracic, passive restoration (shoulder cap only)
$1,880.09
L6380
immediate post-surgical or early fitting, application of
$1,130.00
L6382
immediate post-surgical or early fitting, application of
$1,520.00
L6384
immediate post-surgical or early fitting, application of
$1,764.86
L6386
immediate post-surgical or early fitting, each additional cast
$371.72
L6388
immediate post-surgical or early fitting, application of rigid
$406.94
L6400
below elbow, molded socket, endoskeletal system, including soft
$2,147.89
L6450
elbow disarticulation, molded socket, endoskeletal system,
$2,853.88
L6500
above elbow, molded socket, endoskeletal system, including soft
$2,856.22
L6550
shoulder disarticulation, molded socket, endoskeletal system,
$3,529.76
L6570
interscapular thoracic, molded socket, endoskeletal system,
$4,051.49
L6580
preparatory, wrist disarticulation or below elbow, single wall
$1,446.95
L6582
preparatory, wrist disarticulation or below elbow, single wall
$1,273.99
L6584
preparatory, elbow disarticulation or above elbow, single wa
$1,894.64
L6586
preparatory, elbow disarticulation or above elbow, single wa
$1,734.41
L6588
preparatory, shoulder disarticulation or interscapul
$2,616.40
L6590
preparatory, shoulder disarticulation or interscapul
$2,435.32
L6600
upper extremity additions, polycentric hinge, pair
$173.63
L6605
upper extremity additions, single pivot hinge, pair
$171.44
L6610
upper extremity additions, flexible metal hinge, pair
$154.12
L6615
upper extremity addition, disconnect locking wrist unit
$160.80
L6616
upper extremity addition, additional disconnect insert f
$60.04
L6620
upper extremity addition, flexion-friction wrist unit
$280.66
L6623
upper extremity addition, spring assisted rotational wrist un
$593.77
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L6625
upper extremity addition, rotation wrist unit with cable lock
$492.31
L6628
upper extremity addition, quick disconnect hook adapter, or equal
$443.44
L6629
upper extremity addition, quick disconnect lamination coll
$135.43
L6630
upper extremity addition, stainless steel, any wrist
$529.70
L6632
upper extremity addition, latex suspension sleeve, each
$60.14
L6635
upper extremity addition, lift assist for elbow
$185.00
L6637
upper extremity addition, nudge control elbow lock
$339.89
L6640
upper extremity addition, shoulder abduction joint, pair
$259.30
L6641
upper extremity addition, excursion amplifier pulley type
$148.50
L6642
upper extremity addition, excursion amplifier level type
$201.28
L6645
upper extremity addition, shoulder flexion abduction join
$295.49
L6650
upper extremity addition, shoulder universal joint, each
$313.32
L6655
upper extremity addition, standard control cable, extra
$69.53
L6660
upper extremity addition, heavy duty control cable
$84.96
L6665
upper extremity addition, teflon, or equal cable lining
$42.64
L6670
upper extremity addition, hook to hand, cable adapter
$44.39
L6672
upper extremity addition, harness, chest or shoulder, saddle
$156.07
L6675
upper extremity addition, harness, figure of eight type, for
$111.16
L6676
upper extremity addition, harness, figure of ei
$112.26
L6680
upper extremity addition, test socket, wrist disar
$396.63
L6682
upper extremity addition, test socket, elbow disar
$492.52
L6684
upper extremity addition, test socket, shoulder di
$575.62
L6686
upper extremity addition, suction socket
$546.47
L6687
upper extremity addition, frame type socket, b
$485.00
L6688
upper extremity addition, frame type socket, a
$490.36
L6689
upper extremity addition, frame type soc
$623.71
L6690
upper extremity addition, frame type socket,
$636.49
L6691
upper extremity addition, removable insert, each
$375.00
L6692
upper extremity addition, silicone gel insert or equal, each
$517.66
L6700
terminal device, hook dorrance, or equal, model #3
$480.17
L6705
terminal device, hook dorrance, or equal, model #5
$281.90
L6710
terminal device, hook, dorrance, or equal, model #5x
$456.45
L6715
terminal device, hook, dorrance, or equal, model #5xa
$435.00
L6720
terminal device, hook, dorrance, or equal, model #6
$789.68
L6725
terminal device, hook, dorrance, or equal, model #7
$465.24
L6730
terminal device, hook, dorrance, or equal, model #7lo
$591.50
L6735
terminal device, hook, dorrance, or equal, model #8
$275.82
L6740
terminal device, hook, dorrance, or equal, model #8x
$359.60
L6745
terminal device, hook, dorrance, or equal, model #88x
$329.03
L6750
terminal device, hook, dorrance, or equal, model #10p
$325.22
L6755
terminal device, hook, dorrance, or equal, model #10x
$324.30
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L6765
terminal device, hook, dorrance, or equal, model #12p
$338.82
L6770
terminal device, hook, dorrance, or equal, model #99x
$326.63
L6775
terminal device, hook, dorrance, or equal, model #555
$387.01
L6780
terminal device, hook, dorrance, or equal, model #ss555
$413.69
L6790
terminal device, hook, accu hook or equal
$418.27
L6795
terminal device, hook, 2 load or equal
$1,145.60
L6800
terminal device, hook, aprl vc or equal
$937.88
L6805
terminal device, modifier wrist flexion unit
$314.94
L6806
terminal device, hook, trs grip, vc
$1,219.79
L6809
terminal device, hook, trs super sport, passive
$343.46
L6810
terminal device, pincher tool, otto bock or equal
$172.66
L6825
terminal device, hand, dorrance, vo
$955.02
L6830
terminal device, hand, aprl, vc
$1,253.51
L6835
terminal device, hand, sierra, vo
$1,091.93
L6840
terminal device, hand, becker imperial
$758.59
L6845
terminal device, hand, becker lock grip
$704.22
L6850
terminal device, hand, becker pylite
$637.78
L6855
terminal device, hand, robinids, vo
$811.19
L6860
terminal device, hand, robinids, vo soft
$615.22
L6865
terminal device, hand, passive hand
$301.42
L6875
terminal device, hand, bock vc
$719.47
L6880
terminal device, hand, bock vo
$466.76
L6890
terminal device, glove for above hands, production glove
$190.00
L6895
terminal device, glove for above hands, custom glove
$732.76
L6900
hand restoration (casts, shading and measuremen
$1,989.50
L6905
hand restoration (casts, shading and measuremen
$1,990.23
L6910
hand restoration (casts, shading and measuremen
$2,001.88
L6915
hand restoration (shading and measuremen
$774.57
L6920
wrist disarticulation, external power, self-su
$6,434.34
L6925
wrist disarticulation, external power, self-su
$6,874.02
L6930
below elbow, external power, self-suspended inner socket,
$6,197.18
L6935
below elbow, external power, self-suspended inner socket,
$6,841.72
L6940
elbow disarticulation, external power, molded inner socket,
$8,002.61
L6945
elbow disarticulation, external power, molded inner socket,
$8,927.91
L6950
above elbow, external power, molded inner socket, removable
$7,987.74
L6955
above elbow, external power, molded inner socket, removable
$9,263.27
L6960
shoulder disarticulation, external power, molded inner socket,
$9,744.62
L6965
shoulder disarticulation, external power, molded inner
$11,544.00
L6970
interscapular-thoracic, external power, molded inner
$12,356.57
L6975
interscapular-thoracic, external power, molded inner
$13,619.84
L7010
electronic hand, otto bock, steeper or equal, switch controlled
$3,174.94
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L7015
electronic hand, system teknik, variety village or equal, switc
$5,611.94
L7020
electronic greifer, otto bock or equal, switch controlled
$3,466.69
L7025
electronic hand, otto bock or equal, myoelectronically
$3,428.95
L7030
electronic hand, system teknik, variety village or equal,
$5,488.37
L7035
electronic greifer, otto bock or equal, myoelectronically
$3,648.62
L7040
prehensile actuator, hosmer or equal, switch controlled
$2,609.59
L7170
electronic elbow, boston or equal, switch controlled
$5,427.59
L7180
electronic elbow, boston, utah or equal, myoelectro
$29,891.81
L7260
electronic wrist rotator, otto bock or equal
$1,821.71
L7261
electronic wrist rotator, for utah arm
$3,610.95
L7266
servo control, steeper or equal
$916.48
L7272
analogue control, unb or equal
$1,812.94
L7274
proportional control, 12 volt, utah or equal
$5,621.72
L7360
six volt battery, otto bock or equal, each
$240.00
L7362
battery charger, six volt, otto bock or equal
$242.00
L7364
twelve volt battery, utah or equal, each
$392.77
L7366
battery charger, 12 volt, utah or equal
$540.20
L7499
unlisted procedures for upper extremity prosthesis
BR
L7500
repair of prosthetic device, hourly rate
$80.00
L7510
repair prosthetic device, repair or replace minor parts
BR
L8100
gradient compression stocking, below knee, medium weight, each
BR
L8110
gradient compression stocking, below knee, heavy weight, each
BR
L8120
gradient compression stocking, (linton or equal), each thigh
BR
L8130
gradient compression stocking, thigh length
BR
L8140
gradient compression stocking, thigh length
BR
L8150
gradient compression stocking, thigh length
BR
L8160
gradient compression stocking, full-length, each
BR
L8170
gradient compression stocking, full-length, chap style each
BR
L8180
gradient compression stocking,
BR
L8190
gradient compression stocking, waist length each
BR
L8200
gradient compression stocking, waist length, each
BR
L8210
gradient compression stocking, custom-made
BR
L8220
gradient compression, elastic stocking, lymphedema
BR
L8300
truss, single with standard pad
$58.56
L8310
truss, double with standard pads
$92.46
L8320
truss, addition to standard pad, water pad
$37.11
L8330
truss, addition to standard pad, scrotal pad
$34.27
L8400
prosthetic sheath, below knee, each
$23.02
L8410
prosthetic sheath, above knee, each
$19.18
L8415
prosthetic sheath, upper limb, each
$19.84
L8420
prosthetic sock, multiple ply, below knee, each
$18.01
Code
Abbreviated Orthotic and Prosthetic procedures (L-Codes) A complete listing of procedures and codes is found in HCPCS as adopted by reference in R 418.10107
Map
L8430
prosthetic sock, multiple ply, above knee, each
$20.50
L8435
prosthetic sock, multiple ply, upper limb, each
$19.46
L8440
prosthetic shrinker, below knee, each
$38.71
L8460
prosthetic shrinker, above knee, each
$61.69
L8465
prosthetic shrinker, upper limb, each
$45.16
L8470
stump sock, single ply, fitting, below knee, each
$6.18
L8480
stump sock, single ply, fitting, above knee, each
$8.52
L8485
stump sock, single ply, fitting, upper limb, each
$10.17
L8490
addition to prosthetic sheath/sock, air seal suction retent.
$134.87
L8499
unlisted procedure for miscellaneous prosthetic services
BR
L8500
artificial larynx, any type
BR
L8501
tracheostomy speaking valve
BR
L8610
ocular
BR
L8699
prosthetic implant, not otherwise specified
BR
ORR # 2003-031
DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF WORKERS’ DISABILITY COMPENSATION WORKER’S COMPENSATION HEALTH CARE SERVICES
The Michigan Department of Consumer & Industry Services will hold a public hearing to receive comments from interested persons concerning amendments to the Workers’ Compensation Health Care Services Rules. The following rules are included for comment:
R 418.10106, R 418.10107, R 418.10109, R 418.10202, R 418.10214, R 418.10901, R 418.101002,
R 418.101017, R 418.101022, R 418.101101 and R 418.101504.
The proposed amendments do the following:
· Increases the conversion factor for practitioner services by 1.6% to $47.44.
· Uses the 2003 relative value information to update the Relative Value Units (RVU) for practitioner services.
· Updates all source documents listed in the rules and adopts by reference the 2004 procedure codes for billing purposes.
A hearing will be held as follows:
November 19, 2003 at 9:00 A.M.
2501 Woodlake Circle Conference Room 1 2nd Floor Okemos MI 48864
Interested persons may attend and present their views on the proposed revisions. Anyone presenting oral testimony is required to submit written comments at the time of testimony. Anyone unable to attend may address written comments to the address below. Written comments must be received by November 26, 2003. Copies of the proposed rules are available upon written request to the Bureau. In addition, the proposed rules are published on the following web site: http://www.state.mi.us/orr. The proposed effective date of these rules is January 15, 2004.
Department of Consumer & Industry Services Bureau of Workers’ and Unemployment Compensation
P.O. Box 30016 Lansing, Michigan 48909
Attn: Sheila Wilkinson, Administrator Health Care Services Division
The public hearing is being conducted by the Department under the Administrative Procedures Act of 1969, PA 306, as amended, 1969 PA 317, section 205 as amended, and Executive Reorganization 1996-
2. All hearings are conducted in compliance with the 1990 Americans with Disabilities Act. Hearings are held in buildings that accommodate mobility-impaired individuals and accessible parking is available. A disabled individual requiring additional accommodation for effective participation in a hearing should call (517) 322-5777 to make the necessary arrangements ten business days in advance of the hearing.
ORR # 2003-040
DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES DIRECTOR’S OFFICE
BOARD OF REAL ESTATE APPRAISERS-GENERAL RULES
Filed with the Secretary of State on
These rules take effect 7 days after filing with the Secretary of State
(By authority conferred on the department of consumer and industry services by sections 205, 308, 2605, and 2617 of 1980 PA 299, MCL 339.205, 339.308, 339.2605, and 339.2607, and Executive
Reorganization Order No. 1996-2, MCL 445.2001)
R 339.23101 of the Michigan Administrative Code is amended as follows:
PART 1. GENERAL PROVISIONS
R 339.23101 Definitions.
Rule 101. (1) As used in these rules:
(a) “A course covering the “uniform standards of professional appraisal practice” in section 2627(5) and the “uniform standards of appraisal practice and ethics” in sections 2611(1), 2613(a)(xv), 2614(b)(xv) and 2615(b)(xv) of the act means the 15-hour national USPAP course or the 7-hour national USPAP update seminar, or their equivalent, as required by the AQB real property appraiser qualification criteria, adopted on October 27, 2000, and effective January 1, 2003.
(b) "Act" means 1980 PA 299, MCL 339.101 et seq., and known as the occupational code.
(c) "Board" means the board of real estate appraisers.
(d) "Licensee" means an individual who is licensed under article 26 of the act, including a real estate valuation specialist, a limited real estate appraiser, a state-licensed real estate appraiser, a certified residential real estate appraiser, or a certified general real estate appraiser.
(e) "Market analysis as performed by a real estate licensee” means the activity defined in section 2601(a)(i) and (ii) of the act, and means analysis solely for the purpose of establishing potential sale, purchase, or listing price of real property or the rental rate of real property and is not for the purpose of evaluating a property for mortgage lenders in the primary or secondary mortgage market.
(f) “Real estate consulting”, as used in sections 2613, 2614, and 2615 of the act,
means that function or functions described in standards 4 and 5 of the uniform standards of professional appraisal practice.
(g) “Transaction value” means any of the following:
(i) For loans or other extensions of credit, the amount of the loan or the extension of credit.
(ii) For sales, leases, purchases, and investments, or in exchanges of real property, the market value of the real property interest involved.
(iii) For the pooling of loans or interests in real property for resale or purchase, the
amount of the loan or market value of the real property calculated with respect to each such loan or interest in real property.
(h) “Uniform standards of professional appraisal practice” or “USPAP” means the
uniform standards of professional appraisal practice, published by the Appraisal Foundation, effective January
1,20032004. Copies of the USPAP20032004 edition are available at a cost at the time of adoption of these rules of $30.00 for regular binding and $35.00 for spiral binding plus $8.50 for single copies and $1.00 for each additional copy for shipping, from the Appraisal Foundation, 1029 Vermont Avenue NW, Suite 900, Washington DC 20005-3517. Mail orders: P.O. Box 96724, Washington DC 20090-6734. Phone: toll-free 800/805-7857 or 240/864-0100. Internet address: www.appraisalfoundation.org. The USPAP20032004 edition can be reviewed or purchased from the Department of Consumer & Industry Services, Bureau of Commercial Services, 2501 Woodlake Circle, Okemos Michigan 48824, Phone: 517/241-9236, at a cost as of the time of adoption of these rules of$50.00 plus $11.00 shipping and handling costs.
(2) Terms defined in articles 1 to 6 and 26 of the act have the same meanings when used in these rules.
ORR # 2003-040
DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF COMMERCIAL SERVICES
REAL ESTATE APPRAISER RULES
October 21, 2003
2501 Woodlake Circle Okemos Michigan Conference Room A 2nd floor 9:00 a.m.
The Department of Consumer and Industry Services will hold a public hearing on October 21, 2003, at the Bureau of Commercial Services, 2501 Woodlake Circle, Okemos Michigan in Conference Room A at 9:00 a.m. The hearing will be held to receive public comments on proposed changes to the Administrative Rules for Real Estate Appraisers.
The proposed rules are to update the rules, incorporating the most current edition of the Uniform Standards of Professional Appraisal practice.
These rules are promulgated by authority conferred on the Department of Consumer & Industry Services by sections 308 and 721 of 1980 PA 299, MCL 339.308 and 339.721, and Executive Reorganization Order No. 1996-2, MCL 445.2001. These rules will take effect seven days after filing with the Secretary of State.
The rules [Rule Set 2003-040] are published on the Michigan Government web site at http://www.michigan.gov/orr and in the October 15, 2003 issue of the Michigan Register. Comments may be submitted to the following address by 5:00 p.m. on October 22, 2003. Copies of the draft rules may also be obtained by mail or electronic transmission at the following address:
Department of Consumer and Industry Services Jeannine Benedict, Bureau of Commercial Services
P. O. Box 30018 Lansing MI 48909-7518
Phone: 517/241-9219 FAX: 517/ 241-9280 E-mail: jbened@michigan.gov
The public hearing will be conducted in compliance with the 1990 Americans With Disabilities Act, in an accessible building with handicap parking available. Anyone needing assistance to take part in the hearing can call 517/241-9280 to make arrangements.
