reglab/statecodes huggingface dataset:
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › SURGERY › Section 20-2-II - MULTIPLE PROCEDURES

Current through June 25, 2024
A.
Multiple
				Procedure Reimbursement Rule.
Multiple procedures performed during the same operative
				  session at the same operative site are reimbursed as follows:
* One hundred percent (100%) of the MAR for the primary
				  procedure
* Fifty percent (50%) of the MAR for the second and
				  subsequent procedures
B.
Bilateral Procedure Reimbursement Rule.
Bilateral procedures are
				identical procedures (i.e., use the same CPT code) performed on the same
				anatomic site but on opposite sides of the body. Furthermore, each procedure
				should be performed through its own separate incision to qualify as bilateral.
				For example, open reductions of bilateral fractures of the mandible treated
				through a common incision would not qualify under the definition of bilateral
				and would be reimbursed according to the multiple procedure rule. Medicare's
				accepted method of billing bilateral services is to list the procedure once and
				add modifier 50. Mississippi is adopting this same policy. Refer to the example
				below:
69300 50 Otoplasty, protruding ear, with or without size
				  reduction
Place a "2" in the UNITS column of the CMS-1500 claim form so
				  that payers are aware that two procedures were performed. List the charge as
				  one hundred fifty percent (150%) of your normal charge. Reimbursement shall be
				  at one hundred fifty percent (150%) of the amount allowed for a unilateral
				  procedure(s). For example, if the allowable for a unilateral surgery is one
				  hundred dollars ($100.00) and it is performed bilaterally, reimbursement shall
				  be one hundred fifty dollars ($150.00). However, if the procedure description
				  states "bilateral," reimbursement shall be as listed in the Fee Schedule since
				  the fee was calculated for provision of the procedure bilaterally.
C.
Multiple
				Procedures-Different Areas Rule.
When multiple surgical procedures are
				performed in different areas of the body during the same operative sessions and
				the procedures are unrelated (e.g., abdominal hernia repair and a knee
				arthroscopy), the multiple procedure reimbursement rule will apply
				independently to each area. Modifier 51 must be added.
D.
Multiple Procedure Billing
				Rules
1. The primary procedure, which
				is defined as the procedure with the highest RVU, must be billed with the
				applicable CPT code.
2. The second
				or lesser or additional procedure(s) must be billed by adding modifier 51 to
				the codes, unless the procedure(s) is exempt from modifier 51 or qualifies as
				an add-on code.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › SURGERY › Section 20-2-III - REPAIR OF WOUNDS

Current through June 25, 2024
A. Wound
				classifications of simple, intermediate, or complex are expected to be
				consistent with current CPT descriptions/definitions/guidelines.
B.
Reporting
1. The use of appropriate codes should be
				consistent with the current CPT guidelines.
2. Wound exploration codes should not be
				billed with codes that specifically describe a repair to major structure or
				major vessel. The specific repair code supersedes the use of a wound
				exploration code.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › SURGERY › Section 20-2-IV - MUSCULOSKELETAL SYSTEM

Current through June 25, 2024
A.
Casting
				and Strapping.
This applies to severe muscle sprains or strains that
				require casting or strapping.
1. Initial (new
				patient) treatment for soft tissue injuries must be billed under the
				appropriate office visit code.
2.
				When a cast or strapping is applied during an initial visit, supplies and
				materials (e.g., stockinet, plaster, fiberglass, ace bandages) may be itemized
				and billed separately using the appropriate HCPCS code.
3. When initial casting and/or strapping is
				applied for the first time during an established patient visit, reimbursement
				may be made for the itemized supplies and materials in addition to the
				appropriate established patient visit.
4. Replacement casts or strapping provided
				during a follow-up visit (established patient) include reimbursement for the
				replacement service as well as the removal of casts, splints, or strapping.
				Follow-up visit charges may be reimbursed in addition to replacement casting
				and strapping only when additional significantly identifiable medical services
				are provided. Office notes should substantiate medical necessity of the visit.
				Cast supplies may be billed using the appropriate HCPCS code and reimbursed
				separately.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › SURGERY › Section 20-2-V - BURNS, LOCAL TREATMENT

Current through June 25, 2024
A.
Degree of
				Burns
1. Code 16000 must be used when
				billing for treatment of first degree burns when no more than local treatment
				of burned surfaces is required.
2.
				Codes 16020-16030 must be used when billing for treatment of partial-thickness
				burns only.
3. Codes 16035-16036
				must be used when billing an escharotomy for treatment of a burn.
4. The claim form must be accompanied by a
				report substantiating the services performed.
5. Major debridement of foreign bodies, grease,
				epidermis, or necrotic tissue may be billed separately under codes 11000-11001.
				Modifier 51 does not apply.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › SURGERY › Section 20-2-VI - NERVE BLOCKS

Current through June 25, 2024
A.
Diagnostic
				or Therapeutic
1. Please refer to the
				Pain Management section for guidelines and reimbursement of therapeutic nerve
				blocks.
2. Medications such as
				steroids, pain medication, etc., may be separately billed using the appropriate
				HCPCS code.
a. The name of the medication(s),
				dosage, and volume must be identified.
b. Medication will be reimbursed according to
				fees listed in the HCPCS section. If not listed in HCPCS, reimbursement will be
				according to the Pharmacy section in the General Guidelines.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PATHOLOGY AND LABORATORY › Section 20-2-I - GUIDELINES

Current through June 25, 2024
A.
Pathology Services
. Pathology
				and Laboratory services are provided for evaluating the nature of disease or a
				change in body tissue and organs due to injury and/or caused by a disease.
B.
Separate or 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.
Unlisted Service 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.
D.
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.
E.
By Report (BR)
. "BR" in the Amount column indicates services that
				are too new, unusual, or variable in 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.
F.
Facility Fee
. The Facility
				Fee for outpatient services is the APC Amount.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PATHOLOGY AND LABORATORY › Section 20-2-II - GENERAL INFORMATION AND INSTRUCTIONS

Current through June 25, 2024
A.
Panel
				Tests.
The billing for panel tests must include documentation
				  listing the tests in the panel. When billing for panel tests (80047-80081), use
				  the code number corresponding to the appropriate panel test. These tests will
				  not be reimbursed separately. The panel components do not preclude the
				  performance of other tests not listed in the panel. If other laboratory tests
				  are performed in conjunction with a particular panel, the additional tests may
				  be reported separately in addition to the panel.
B.
Handling and Collection
				Process
1. In collecting a specimen,
				the cost for collection is covered by the technical component when the lab test
				is conducted at that site. No separate collection or handling fee for this
				purpose will be reimbursed.
2. When
				a specimen must be sent to a reference laboratory, the cost of specimen
				collection is covered in a collection fee. This charge is only allowed when a
				reference laboratory is used, and modifier 90 must be used.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-I - SCOPE

Current through June 25, 2024
A.
Therapeutic Services
.
				Therapeutic services are an integral part of the healing process for a variety
				of injured workers. Recognizing this, the Fee Schedule includes codes for
				physical medicine, modalities, procedures, tests, and measurements in the
				Therapeutic Services section representing specific therapeutic procedures
				performed by licensed physicians, chiropractors, licensed physical therapists,
				licensed occupational therapists, and speech pathologists.
B.
Selection of Providers.
Physical or occupational therapy, including work hardening, functional
				capacity evaluations, chronic pain programs, or massage therapy shall be
				provided upon referral from a physician. In the absence of specific direction
				from the treating or prescribing physician, the selection of a provider for
				these services shall be made by the payer in consultation with the treating or
				prescribing physician.
No party, in attempting to negotiate a repricing or other
				  post treatment price reduction agreement, shall state or imply that consent to
				  such an agreement is mandatory, or that the failure to enter into any such
				  agreement may result in audit, delay of payment, or other adverse consequence.
				  If the MWCC determines that any party, or other person in privity therewith,
				  has made such false or misleading statements in an effort to coerce another
				  party's consent to a repricing or other price reduction agreement outside the
				  Fee Schedule, the MWCC may refer the matter to the appropriate authorities to
				  consider whether such conduct warrants criminal prosecution under §
										71-3-69
				  of the Law.
C.
Physical Medicine Assessment
1.
				An assessment must be performed to determine if a patient will benefit from
				therapeutic services.
2. When a
				physician examines a patient and an assessment for therapeutic services is
				performed, the billing for the office visit includes the therapeutic
				assessment.
3. Procedure codes
				97161-97163 are used for an initial assessment by physical therapists. Code
				97164 is used for re-evaluation of a patient by physical therapists. Procedure
				codes 97165-97167 are used for an initial assessment by occupational
				therapists. Code 97168 is used for re-evaluation of a patient by occupational
				therapists. Procedure codes from 92521-92523 are used for an initial assessment
				by a speech-language pathologist.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-II - REIMBURSEMENT

Current through June 25, 2024
A.
Guidelines
1. Visits for therapy may not exceed one
				visit per day without prior approval from the payer.
2. Therapy exceeding fifteen (15) visits or
				thirty (30) days, whichever comes first, must have prior authorization from the
				payer for continuing care. It must meet the following guidelines:
a. The treatment must be medically necessary.
b. Prior authorization may be made
				by telephone. Documentation should be made in the patient's medical record
				indicating the date and name of the payer representative giving authorization
				for the continued therapy.
3. Reimbursement is limited to no more than
				four (4) therapies concurrently at the same visit. In the event of multiple
				treatment areas, an additional four (4) therapies per treatment day may be
				allowed at the payer's discretion and with pre-authorization. In the event of
				multiple treatment areas, the second and subsequent areas are subject to the
				multiple procedure rule.
4. Payment
				for 97010, which reports application of hot or cold packs, is bundled into
				payment for other services. Separate reimbursement for hot and cold packs will
				not be allowed in the treatment of work-related injury/illness.
5. Only one (1) work hardening or work
				conditioning program is reimbursed per injury.
6. The Physical Therapist Assistant or
				Occupational Therapist Assistant shall be reimbursed at eighty-five percent
				(85%) of the maximum allowable for the procedure. Mississippi modifier "M3"
				should be attached to the appropriate CPT code(s) when billing services
				rendered by a Physical Therapist Assistant or an Occupational Therapist
				Assistant.
7. NCCI edits or other
				bundle/unbundle edits do not apply to the CPT codes in the Therapeutic Services
				section, other than the stated rules provided in this section.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-IV - FUNCTIONAL CAPACITY EVALUATIONS

Current through June 25, 2024
A. The functional
				capacity evaluation (FCE) is utilized for the following purposes:
1. To determine the highest level of safe
				functionality and of maximal medical improvement;
2. To provide a pre-vocational baseline of
				functional capabilities to assist in the vocational rehabilitation
				process;
3. To objectively set
				restrictions and guidelines for return to work;
4. To determine whether specific job tasks
				can be safely performed by modification of technique, equipment, or by further
				training;
5. To determine whether
				additional treatment or referral to a work hardening program is indicated;
				and
6. To assess outcome at the
				conclusion of a work hardening program.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-V - TENS UNITS

Current through June 25, 2024
A. TENS
				(transcutaneous electrical nerve stimulation) must be provided under the
				attending or treating physician's prescription.
B. Authorization from the payer must be
				sought before purchase or rental arrangements are made for a TENS unit. The
				payer has sole right of selection of vendors for rental or purchase of
				equipment, supplies, etc.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-VI - SUPPLIES, EQUIPMENT, ORTHOTICS, AND PROSTHETICS

Current through June 25, 2024
A.
				Physicians and therapists must obtain authorization from the payer before
				purchase/rental of supplies, equipment, orthotics, and prosthetics costing more
				than three hundred dollars ($300.00) per item for workers' compensation
				patients. When submitting bills, include the appropriate HCPCS code. If there
				is not an appropriate HCPCS code, use CPT code 99070.
B. The payer has sole right of selection of
				vendors.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-VII - OTHER INSTRUCTIONS

Current through June 25, 2024
A. Charges will not
				be reimbursed for publications, books, or digital media unless prior approval
				of the payer is obtained.
B. All
				charges for services must be clearly itemized by CPT code, and the state
				professional license number must be on the bill.
C. The treating physician must approve and
				sign all physical capability/restriction forms for the work-related
				injury/illness. This form must be submitted to the payer within fourteen (14)
				working days of the release to work.
D. Documentation may be required by the payer
				to substantiate the necessity for treatment rendered. Documentation to
				substantiate charges and reports of tests and measurements are included in the
				fee for the service and do not warrant additional reimbursement.
E. When patients do not show measurable
				progress, the payer may request the physician discontinue the treatment or
				provide documentation to substantiate medical necessity.
F. When physical medicine therapies are
				provided to more than one body area, modifier 51 must be added to the procedure
				code or codes billed for the additional body area and will be reimbursed
				according to the multiple procedure rule.
G. Non-surgical debridement of active wounds
				should be billed as CPT code 97597, 97598, or 97602.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-IX - MASSAGE THERAPY

Current through June 25, 2024
Massage therapy requires prior authorization of the payer
				  before treatment can be rendered. Medical necessity must be established prior
				  to approval. Reimbursement must be arranged between the payer and
				  provider.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-X - CHIROPRACTIC MANIPULATIVE TREATMENT

Current through June 25, 2024
Chiropractic manipulative treatments are allowed for up to
				  fifteen (15) visits or thirty (30) days, whichever first occurs, without any
				  need to seek pre-certification or authorization. However, chiropractic
				  manipulative treatments which are proposed beyond the first fifteen (15) visits
				  or thirty (30) days, under any circumstance, must be pre-certified or
				  pre-approved.
Like any other service, a spinal manipulation includes
				  pre-evaluation and post-evaluation that would make it inappropriate to bill
				  with an E/M service. However, if the patient's condition has deteriorated or an
				  injury to another site has occurred, reimbursement can be made for an E/M
				  service if documentation substantiates the separate additional service.
				  Modifier 25 is added to an E/M service when a significant, separately
				  identifiable E/M service is provided and documented as medically
				  necessary.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › THERAPEUTIC SERVICES › Section 20-2-XI - CHRONIC PAIN - INTER-DISCIPLINARY PAIN REHABILITATION PROGRAM

Current through June 25, 2024
A.
				The Inter-Disciplinary Pain Rehabilitation (IDPR) program is based on the
				bio-psychosocial approach to managing chronic pain, and uses both physical
				medicine treatments as well as psychological treatments and therapy to manage
				the chronic pain patient. A goal oriented, team approach is used in an effort
				to reduce pain, improve functioning, and decrease the dependence on the health
				care system of persons with chronic pain. This is an outpatient
				program.
B.
				Authorization/pre-certification is required in order to utilize an
				inter-disciplinary pain rehabilitation program to treat the chronic pain
				patient. A specific IDPR program plan must be submitted to the payer as part of
				the authorization/pre-certification process.
C. The following guidelines shall be used to
				assist in pre-certification, and concurrent review:
1. Persons considered suitable candidates for
				an inter-disciplinary pain rehabilitation program are those:
a. Who are likely to benefit from the program
				design;
b. Whose symptoms are
				deemed by a pain management provider to constitute chronic pain syndrome; and
c. Whose medical, psychological,
				or other conditions do not prohibit participation in this program.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DENTAL › Section 20-2-I - SCOPE

Current through June 25, 2024
The dental procedure codes included in the 2019 Mississippi
				  Workers' Compensation Medical Fee Schedule are obtained from the Code on Dental
				  Procedures and Nomenclature 2019 which is published in
Current Dental Terminology
(CDT),
				  American Dental Association (ADA). All Rights Reserved. CDT codes are
				  five-character codes beginning with "D" and followed by four numeric digits.
				  Billing for dental services should be submitted on the ADA Dental Claim
				  Form.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › DENTAL › Section 20-2-II - GUIDELINES

Current through June 25, 2024
A. Treatments provided for work-related
				dental injuries not specifically contained in the Fee Schedule should be billed
				using CDT code D9999 "Unspecified Adjunctive Procedure, By Report."
B.
By Report (BR).
"BR" in the
				Amount column indicates services that are too new, unusual, or variable in 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.
C.
Dental
				Providers:
The following dental providers, licensed in the state where
				they practice, may be paid for dental services:
1. Dentists
2. Oral and maxillofacial surgeons
3. Orthodontists
4. Hospitals
5. Dental clinics
Services provided by other dental practitioners, including
				  hygienists and dental assistants, must be billed by the licensed dentist,
				  orthodontist or oral surgeon overseeing these practitioners.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HCPCS › Section 20-2-I - Definition

Current through June 25, 2024
HCPCS is an acronym for CMS's Healthcare Common Procedural
				  Coding System. It is divided into two subsets. HCPCS Level I codes are CPT
				  codes developed and maintained by the AMA. HCPCS Level II codes are developed
				  and maintained by CMS and include codes for procedures, equipment, and supplies
				  not found in the CPT book. This section of the Fee Schedule contains HCPCS
				  Level II codes. (See the Dental section for dental codes.) HCPCS Level II codes
				  that are excluded from the Fee Schedule are Alcohol/Drug Abuse Treatment
				  Services (H0001 - H2037), and National Codes for State Medicaid Agencies (T1000
				  - T5999). Code categories included in this section are as follows:
Transportation Services Including
							 Ambulance
A0021-A0999
Medical/Surgical Supplies
A4206-A8004
Administrative, Misc., and
							 Investigational
A9150-A9999
Enteral and Parenteral Therapy
B4000-B9999
Outpatient PPS
C1300-C9899
Durable Medical Equipment (DME)
E0100-E9999
Procedures/Professional Services
							 (Temporary)
G0008-G9186
Drugs and Biologicals
J0120-J9999
K Codes (Temporary)
K0001-K9999
Orthotic Procedures
L0000-L4999
Prosthetic Procedures
L5000-L9999
Medical Services
M0000-M0301
Pathology and Laboratory Services
P0000-P9999
Q Codes (Temporary)
Q0035-Q9980
Diagnostic Radiology Services
R0000-R5999
Temporary National Codes (Non-Medicare)
S0000-S9999
Vision Services
V0000-V2999
Hearing Services
V5000-V5999
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HCPCS › Section 20-2-I - DEFINITION

Current through June 25, 2024
HCPCS is an acronym for CMS's Healthcare Common Procedure
				  Coding System. It is divided into two subsets. HCPCS Level I codes are CPT
				  codes developed and maintained by the AMA. HCPCS Level II codes are developed
				  and maintained by CMS and include codes for procedures, equipment, and supplies
				  not found in CPT . This section of the Fee Schedule contains HCPCS Level II
				  codes. HCPCS Level II codes for Alcohol/Drug Abuse Treatment Services
				  (H0001-H2037) and National Codes for State Medicaid Agencies (T1000-T5999) are
				  not included in the Fee Schedule. Code categories included in this section are
				  as follows:
Transportation Services Including Ambulance
A0021-A0999
Medical/Surgical Supplies
A4206-A9286
Administrative, Misc., and Investigational
A9150-A9999
Enteral and Parenteral Therapy
B4034-B9999
Outpatient PPS
C1713-C9899
Durable Medical Equipment (DME)
E0100-E8002
Procedures/Professional Services (Temporary)
G0008- G9987
Drugs and Biologicals
J0120-J9999
K Codes (Temporary)
K0001-K0900
Orthotic Procedures
L0112-L4631
Prosthetic Procedures
L5000-L9900
Medical Services
M0075-M1071
Pathology and Laboratory Services
P2028-P9615
Q Codes (Temporary)
Q0035-Q9992
Diagnostic Radiology Services
R0070-R0075
Temporary National Codes (Non-Medicare)
S0012-S9999
Vision Services
V2020-V2799
Hearing Services
V5008-V5364
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HCPCS › Section 20-2-II - Guidelines

Current through June 25, 2024
A.
Transportation Services Including
				Ambulance (A0021 - A0999)
1.
				Transportation service codes include ground and air ambulance, non-emergency
				transportation (taxi, bus, automobile, wheelchair van), and ancillary
				transportation-related fees.
2. No
				exemption for air ambulance according to the Airline Deregulation Act (ADA) is
				allowed based on the rules and regulations of the current 2016 MWCC Fee
				Schedule.
3. Modifiers are required
				when reporting transportation services. Modifiers are single digits used to
				identify origin and destination. The first modifier identifies the transport
				place of origin and the second modifier the destination. Origin and destination
				modifiers are as follows:
D
Diagnostic or therapeutic site other than "P"
				  or "H" when these are used as origin codes
E
Residential, domiciliary, custodial facility
				  (other than 1819 facility)
G
Hospital-based ESRD facility
H
Hospital
I
Site of transfer (e.g., airport or helicopter
				  pad) between modes of ambulance transport
J
Free-standing ESRD facility
N
Skilled nursing facility (SNF)
P
Physician's office
R
Residence
S
Scene of accident or acute event
X
Intermediate stop at physician's office on way
				  to hospital (includes HMO non-hospital facility, clinic, etc. destination code
				  only).
Note:
Modifier X can only be used as a
				  destination code in the second position of a modifier.
4. Transportation codes can also be found in
				the S codes. See S0207, S0208, S0209, and S0215.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HCPCS › Section 20-2-II - GUIDELINES

Current through June 25, 2024
A. Rental or purchase of supplies or
				equipment over the amount of $300.00 per item requires Prior Authorization.
B.
Transportation Services
				Including Ambulance (A0021-A0999)
1.
				Transportation service codes include ground and air ambulance, non-emergency
				transportation (taxi, bus, automobile, wheelchair van), and ancillary
				transportation-related fees.
2. No
				exemption for air ambulance according to the Airline Deregulation Act (ADA) is
				allowed based on the rules and regulations of the 2019 MWCC Fee Schedule.
3. Modifiers are required when
				reporting transportation services. Modifiers are single digits used to identify
				origin and destination. The first modifier identifies the transport place of
				origin and the second modifier the destination. Origin and destination
				modifiers are as follows:
D.
Diagnostic or therapeutic site other than "P"
				  or "H" when these are used as origin codes;
E.
Residential, domiciliary, custodial facility
				  (other than 1819 facility);
G.
Hospital-based ESRD facility;
H.
Hospital;
I.
Site of transfer (e.g., airport or helicopter
				  pad) between modes of ambulance transport;
J.
Free-standing ESRD facility;
N
Skilled nursing facility (SNF);
P.
Physician's office;
R.
Residence;
S.
Scene of accident or acute event; and
X.
Intermediate stop at physician's office on
				  way to hospital (includes HMO non-hospital facility, clinic, etc. destination
				  code only).
Note:
Modifier X can only be used as a
				  destination code in the second position of a modifier.
4. Transportation codes can also be found in
				the S codes. See S0207, S0208, S0209, and S0215.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HCPCS › Section 20-2-III - Modifiers

Current through June 25, 2024
HCPCS modifiers are required for some supplies and services.
				  Commonly reported HCPCS modifiers include:
AU Item Furnished in Conjunction with a
				  Urological, Ostomy, or Tracheostomy Supply
AV Item Furnished in Conjunction with a
				  Prosthetic Device, Prosthetic, or Orthotic
AW Item Furnished in Conjunction with a
				  Surgical Dressing
KC Replacement of Special Power Wheelchair
				  Interface
NU New Equipment
RR Rental (use the RR modifier when DME is to
				  be rented)
Mississippi guideline: Listed amount is the per-month
				  allowance, except codes E0676, E0935, and E0936, which are per-day
				  allowances.
UE Used durable medical equipment
Mississippi guideline: Used to report the purchase of
				  used durable medical equipment.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-II - INPATIENT REHABILITATION FACILITIES (IRFS)

Current through June 25, 2024
A.
Inpatient Rehabilitation Facility Reimbursement Methodology.
Reimbursement for inpatient rehabilitation facilities (IRFs) will be based upon
				the CMS prospective payment system (PPS).
1.
				The Fee Schedule MAR for IRFs will be 1.8 times the IRF CMS pricer calculation,
				unless the payer and provider have a separate contract governing the
				reimbursement of services provided by an IRF, or unless total billed charges
				are less.
2. The IRF reimbursement
				due under this Fee Schedule will be calculated using the CMS IRF pricer
				calculation in effect on the date of discharge.
3. The CMS IRF pricer is used only for
				facilities that have met the CMS qualifications for IRF.
4. Reimbursement for IRFs is not calculated
				using the MS-DRG methodology.
5.
				The CMS IRF pricer is available at: http://www.cms.hhs.gov/PCPricer [File Link
				Not Available]
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-IV - CRITICAL ACCESS HOSPITALS

Current through June 25, 2024
A. A critical
				access hospital (CAH) is a small, generally geographically remote facility that
				is certified to provide outpatient and inpatient services.
B. A CAH may also be granted "swing bed"
				approval to provide post-hospital skilled nursing facility level care in its
				inpatient beds.
C. A list of
				currently participating Mississippi Critical Access hospitals is posted on the
				MWCC website at http://www.mwcc.ms.gov/ [File Link Not Available]
D. Reimbursement
1. Critical access hospitals are reimbursed
				at ninety percent (90%) of billed charges for inpatient services.
2. Swing bed services are reimbursed
				according to the Skilled Nursing Facility rules below.
3. Outpatient services are reimbursed
				according to the rules in Inpatient Hospital and Outpatient Facility Payment
				Schedule and Rules.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-V - SKILLED NURSING FACILITY RULES

Current through June 25, 2024
A.
Reimbursement
The MAR for medical care provided within the
				confines of a freestanding skilled nursing facility, a hospital-based skilled
				nursing facility, or a swing bed facility, shall be four hundred dollars
				($400.00) per day. This rate covers and includes all routine and ancillary
				health care services provided to a claimant during each day of a covered
				skilled nursing facility stay.
B.
Excluded Services
The following services are excluded from the
				daily skilled nursing facility rate, and shall be reimbursed separately and in
				addition to the above daily rate:
* Cardiac catheterization;
* Angiography;
* Magnetic resonance imaging (MRI) and computerized axial
				  tomography (CT) scans;
* Radiation therapy and chemotherapy;
* Emergency services, which are defined as an admission or
				  services necessitated by a sudden onset of illness or injury which is
				  manifested by acute symptoms of sufficient severity that the failure to provide
				  services could reasonably result in:
- serious impairment of bodily function(s);
- serious or permanent dysfunction of any bodily organ or
				  part or system;
- permanently placing the person's health in jeopardy; or
- other serious medical consequence.
* Outpatient services when provided in a hospital or other
				  free standing outpatient facility separate from the skilled nursing facility;
* Customized prosthetic services;
* Ambulance transportation related to any of the above
				  services; and
* Services provided independent of the facility by
				  physicians, and other qualified health care professionals (e.g., NP, PA, CRNA,
				  psychologist).
C.
Exclusions
As in other cases, the above provisions shall not apply
				to any mutual agreement or contract entered into by the payer and provider
				which sets forth the terms for the provision of skilled nursing facility
				services and reimbursement therefor.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › INPATIENT HOSPITAL AND OUTPATIENT FACILITY PAYMENT SCHEDULE AND RULES › Section 20-2-VI - DRUG AND ALCOHOL TREATMENT

Current through June 25, 2024
A. Any admission
				for drug and alcohol treatment will be reimbursed by DRG according to the
				facility inpatient rules.
B. 
				Outpatient partial day treatment will be reimbursed at two hundred fifty
				dollars ($250.00) per diem.
C.
				Outpatient lab and radiology charges will be reimbursed according to the
				outpatient stand-alone rules in the facility section.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-I - Introduction

Current through June 25, 2024
There is insufficient data to show the long-term use of
				  opioids effectively treats chronic non-malignant pain 
				  i. Chronic pain has been variably
				  defined but is defined within this guideline as pain that typically lasts more
				  than three months or past the time of normal tissue healing.
There is sufficient data to show opioid pain medication use
				  presents serious risks, including overdose and opioid use disorder.
				  Nevertheless, opiates are commonly prescribed for pain. An estimated 20% of
				  patients presenting to physicians' offices with non-cancer pain symptoms or a
				  pain-related diagnosis receive an opioid prescription 
				  ii. In 2012, 259 million prescriptions
				  for opioids were written in the United States, enough for every adult in the
				  United States to have a bottle of pills 
				  iii. And rates of opioid prescribing
				  vary greatly across states in ways that cannot be explained by the underlying
				  health status of the population. 
				  iv
The use of prescription opioids has risen significantly in
				  the last fifteen years, more so for family physicians, general practice
				  physicians, and internal medicine physicians, compared with other specialties 
				  v. As the number of opioid
				  prescriptions for chronic pain have increased, so has the incidence of
				  addiction. From 1999 to 2014, more than 165,000 persons died from overdoses
				  related to opioid pain medications in the United States 
				  vi. A recent study of patients B ages
				  15 to 64 who received opioids for chronic noncancerous pain and were followed
				  for up to 13 years B revealed that 1 in 550 patients died from opioid-related
				  overdose at a median of 2.6 years from their first prescription. One in 32
				  patients who escalated opioid dosage greater than 200-morphine-mg equivalence
				  died from opioid-related overdose 
				  vii.
Opioids have also been associated with increased duration of
				  disability, even when adjusted for injury severity in injured workers with back
				  pain 
				  viii.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-II - Scope

Current through June 25, 2024
These guidelines do not focus broadly on pain management, but
				  rather focus on the use of opioids to manage non-cancer related pain. They
				  apply to all clinicians who prescribe opioids, including nurse practitioners,
				  physician assistants, podiatrists and dentists.
Clinicians should follow the guidelines. However, failure to
				  follow a guideline will not warrant a denial of service, with the following
				  exceptions: Section
V.
C;
VII.
B. 9.; E. 2. and 3. and
				  F. 1. and 2.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-III - Acute versus Chronic Pain

Current through June 25, 2024
A.
Acute Pain
Long-term opioid use often begins with treatment of acute
				  pain. When opioids are used for acute pain, clinicians should prescribe (a) the
				  lowe
st
effective dose of immediate release opioids (b) in no
				  greater quantity than needed for the expected duration of the pain that is
				  severe enough to require opioids. Three days or less will often be sufficient.
				  More than seven days will rarely be needed.
B.
Chronic
				Pain
Opioids are not the preferred treatment for chronic pain.
				  Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred
				  for chronic pain. Clinicians should consider opioid therapy only if expected
				  benefits for both pain and function are expected to outweigh risks to the
				  patient. If opioids are used, they should be combined with non-pharmacologic
				  therapy and non-opioid pharmacologic therapy, as appropriate.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-IV - Opioids Pharmacology

Current through June 25, 2024
A.
Important Distinctions
* Tolerance refers to a state of adaptation in which exposure
				  to a drug over time causes higher doses to be required to produce the same
				  physiologic effect and/or marked diminished effect with continued use of the
				  same amount of that drug.
* Dependence refers to a set of disturbances and body
				  homeostasis that lead to withdrawal symptoms which are produced with abrupt
				  discontinuation or rapid reduction of a medication. Administration of an
				  antagonist can also initiate withdrawal symptoms.
* Addiction is a primary chronic neuro-biological disease
				  with genetic, psychological, and environmental factors influencing its
				  development and manifestations. It is a behavior pattern of drug craving and
				  seeking which leads to preoccupation with drug procurement and aberrant pattern
				  of use. The drug use is frequently associated with negative
				  consequences.
B.
Choice of Opioids
The following guidelines apply when choosing an opioid.
1. There is no evidence that one
				long-acting opioid is more effective than another in improving function.
2. There is also no evidence that
				long-acting opioids are superior to short-acting opioids for improving function
				or pain or causing less addiction.
3. Long-acting opioids should not be used in
				the treatment of acute, subacute, or postoperative pain.
4. When choosing long-acting opioids for
				chronic pain management, it is reasonable to consider cost given the lack of
				superiority profiles for one medication over another.
5. There is no single formula for
				pharmacologic treatment of patients with chronic non-malignant pain.
6. Medications with a greater safety profile
				should be used initially.
7. Use of
				methadone requires special precautions. Methadone may cause cardiac arrhythmia
				due to QT prolongation and has been linked to a greater number of deaths
				secondary to its prolonged half-life.
8. Meperidine should not be used for chronic
				pain. Meperidine and its active metabolite normeperidine present a serious risk
				of seizure and hallucinations.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-V - General Caveats

Current through June 25, 2024
A.
Extreme Caution Needed
Extreme caution should be used when prescribing opioids for
				  patients with one or more of these issues:
1. history of alcohol or other substance
				abuse;
2. chronic benzodiazepine
				use;
3. uncontrolled sleep apnea;
4. severe personality disorder or
				other known severe psychiatric disease;
5. decreased physical and mental function
				with continued opioid use; and
6.
				addiction behaviors including preoccupation with drugs, strong preference for
				short-acting over long-acting opioids, use of multiple prescribers/pharmacies,
				use of street drugs or other patient's drugs, not taking medications as
				prescribed, losing medication on more than one occasion, and criminal behaviors
				such as forged prescriptions
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-VI - Conducting the Initial Evaluation

Current through June 25, 2024
A thorough history and physical examination are the
				  well-established foundation for diagnostic and therapeutic procedures.
A.
History
The history should include:
1. general information: name, age, gender,
				etc.;
2. work history, including
				current job status and requirements of current job
3. current employment status;
4. impact on activities of daily living;
5. past and present psychological
				problems;
6. previous physical,
				emotional, or sexual abuse;
7.
				sleep disturbances;
8. pain
				history, including site of pain, visual analog scale, duration, onset,
				characteristics such as burning, shooting, stabbing, as well as aggravating or
				alleviating activities;
9. current
				and previous medication use;
10.
				history of substance abuse (i.e. alcohol, smoking, street drugs, opioids);
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-VII - Managing Patients Placed on Long-Term Opioids

Current through June 25, 2024
A.
Psychological Evaluation
Patients who are placed on long-term opioids (3 months)
				  should undergo a psycho-social evaluation, including formal psychological
				  testing by a psychologist with a Ph.D. or a physician with the appropriate
				  credentials, as well as consideration for a concomitant interdisciplinary
				  rehabilitation treatment. It is preferable that these professionals have
				  experience in diagnosing and treating chronic pain conditions and that patients
				  thoroughly under-stand the need to pursue pain management techniques in
				  addition to medication use in order to function with chronic pain.
B.
Contraindications to Prescribing Opioids beyond Three
				Months
1. Opioids should
				be discontinued if the patient did not meet the goals to improve pain and
				function - particularly the functional goals - that were formulated when
				opioids were initiated.
2. Opioids
				should be discontinued if a psychological evaluation deems the patient a
				high-risk candidate for the use of controlled substances.
3. Opioids should be discontinued if they
				have not reduced the patient's subjective pain complaints by 30%, at a
				minimum.
4. Opioids should be
				discontinued if a patient cannot perform at least a sedentary level of work
				because of sedentary pain complaints. A patient may still be disabled from
				underlying significant objective physical abnormalities (i.e. severe neurologic
				deficit, loss of limb, severe structural orthopedic abnormalities, etc.).
5. Opioids should be discontinued
				if the patient cannot function secondary to side effects from the medication.
6. Opioids should be discontinued
				if the patient refuses non-interventional treatment options that might improve
				physical functioning and pain levels (i.e. physical therapy, cognitive
				behavioral therapy).
7. Opioids
				should be discontinued if the patient shows significant nonorganic behaviors,
				such as strongly positive Waddell's signs.
8. Opioids should be discontinued:
a. when the patient receives prescriptions
				from more than one practitioner; or
b. when the patient has inconsistent drug
				screens, absent extenuating circumstances. Prior to discontinuation of the
				opiate, a confirmation GCMS drug screen must be done on the sample to ensure
				that a false-positive or false-negative has not occurred.
9. If there are extenuating circumstances
				which lead a clinician to believe an opioid should be continued despite one of
				the above contraindications, these must be clearly documented.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › Mississippi Workers' Compensation Commission Guidelines for the Prescription of Opiates › Section 20-2-VIII - Tapering of Opioids

Current through June 25, 2024
A. Clinicians
				should evaluate the benefits and harms of continued therapy on a routine basis.
				If documented benefits do not outweigh harms, opioids should be tapered
and discontinued
.
B. Patients who fail a trial of opioid
				medications but do not have an issue with addiction will not need to see an
				addictionologist. These patients can be tapered safely off their medications by
				their treating physicians. Weaning protocols vary. Conservative approach
				recommends a 10% reduction in the original dose per week. Other sources state
				that a 25% reduction every four days should avoid withdrawal syndrome. If drug
				diversion is suspected, then prescribing additional opiates is not indicated.
				The prescription of additional opiates in this situation will constitute a
				greater risk to the patient or the community than the potential for withdrawal
				syndrome.