Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MEDICINE SERVICES › Section 20-2-I - GUIDELINES

Current through June 25, 2024
A.
Unlisted Services or
				Procedures
. When reporting a service or procedure that is not listed in
				this fee schedule, use the appropriate unlisted procedure code. The bill must
				be accompanied by a Special Report as described below. If a HCPCS or CPT code
				has been established subsequent to the release of this fee schedule, include
				the code(s) with the Special Report.
B.
Multiple Procedures
. When
				multiple procedures are performed on the same date or at the same session, it
				is appropriate to designate them by separate entries.
C.
Separate Procedures
.
				Separate procedures are commonly carried out as an integral component of
				another procedure. They should not be billed in conjunction with the related
				procedure. These procedures may be billed when performed independently by
				adding modifier 59 to the specific "separate procedure" code.
D.
By Report (BR
) . "BR" in the
				Amount column indicates services that are too new, unusual, or variable in the
				the nature of their performance to permit the assignment of a definable fee.
				Such services should be substantiated by documentation submitted with the bill.
				Sufficient information should be included to permit proper identification and a
				sound evaluation.
E.
Special
				Report
. Any test/service that is not provided routinely should be
				reported with the appropriate code designating the service and the billing for
				that test/service should include a description of the procedure, the process
				used, and a full report of the findings. Special reports to justify the
				necessity of a service do not warrant a separate fee.
F.
Materials Supplied by
				Physician
. Supplies and materials usually included in an office visit
				are included in the reimbursement for the office visit. Other unusual supplies
				and materials should be identified with CPT code 99070 or a specific HCPCS
				code. Reimbursement shall be limited to the lesser of the billed amount, the
				Fee Schedule MAR or the usual and customary rate for items not listed in this
				Fee Schedule.
G.
Audiological
				Function Tests
. The audiometric tests (92551-92597) require the use of
				calibrated electronic equipment, recording of results and a report with
				interpretation. Hearing tests (such as whispered voice, tuning fork) that are
				otorhinolaryngologic Evaluation and Management services are not reported
				separately.. All services include testing of both ears. Use modifier 52 if a
				test is applied to one ear instead of two ears.
H.
Psychological Services
1. Payment for a psychiatric diagnostic
				interview/evaluation includes history and mental status determination,
				development of a treatment plan when necessary and the preparation of a written
				report that must be submitted with the required billing form. Use of an E/M
				code with a diagnostic interview/evaluation is not appropriate.
2. Psychotherapy codes are used regardless of
				place of service. The CPT code most closely matching the length of the session
				must be billed.
3. Use of an E/M
				code with a psychotherapy code should follow the guidelines from CPT and
				American Psychiatric Association recommendatations.
4. A service level adjustment factor is used
				to determine payment for psychotherapy when a provider other than a
				psychiatrist provides the service. In those instances, the reimbursement amount
				for the CPT code is paid at eighty-five percent (85%) of the maximum
				reimbursement allowance. This applies to psychologists, social workers,
				counselors and other non-physician providers.