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

Current through June 25, 2024
A.
Medications
are defined as
				drugs prescribed by a licensed health care provider and include name brand and
				generic drugs as well as patented or over-the-counter drugs, compound drugs and
				physician-dispensed or repackaged drugs.
B.
Average Wholesale Price (AWP)
means Average Wholesale Price based on data obtained from manufacturers. Under
				this Fee Schedule, drugs should be reimbursed according to the AWP based on the
				most current edition of the Drug Topics Red Book in effect at the time the
				medication is dispensed.
Pharmacy bills should be submitted using the NCPDP Workers'
				  Compensation/Property and Casualty Claim Form or the equivalent NCPDP
				  electronic format. Forms can be obtained
				  here:https://www.ncpdp.org/Products/Universal-Claim-Forms [File Link Not
				  Available] Nothing shall prohibit parties from using an agreed upon billing
				  form or format.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PHARMACY RULES › Section 20-2-III - RULES

Current through June 25, 2024
In the event that the MWCC implements a drug formulary, the
				  Formulary and any subsequent Pharmacy Fee Schedule will govern and supersede
				  the rules in this Fee Schedule where they conflict.
A. Generic Equivalent Drug Products. Unless
				otherwise specified by the ordering physician, all prescriptions will be filled
				under the generic name.
When the physician writes "brand medically necessary" on the
				  prescription, the pharmacist will fill the order with the brand name. When
				  taking telephone orders, the pharmacist will assume the generic is to be used
				  unless "brand medically necessary" is specifically ordered by the treating
				  physician. Without exception, the treating physician has the authority to order
				  a brand name medication if he/she feels the brand name drug is substantially
				  more effective.
B. A payer
				or provider may not prohibit or limit any person from selecting a pharmacy or
				pharmacist of his/her choice, and may not require any person to purchase
				pharmacy services, including prescription drugs, exclusively through a
				mail-order pharmacy or program, or to obtain medication dispensed by the
				physician or in the physician's office, provided the pharmacy or pharmacist
				selected by the claimant has agreed to be bound by the terms of the Workers'
				Compensation Law and this Fee Schedule with regard to the provision of services
				and the billing and payment therefor.
C. Dietary supplements, including but not
				limited to minerals, vitamins, and amino acids are not reimbursable unless a
				specific compensable dietary deficiency has been clinically established as
				related to the work injury.
D. Not
				more than one dispensing fee shall be paid per drug within a thirty (30) day
				period.
E. Providers should refer
				to the Mississippi Workers' Compensation Commission Guidelines for the
				Prescription of Opiates for rules relating to opiate prescriptions. The
				guidelines are available on the MWCC website at
				https://mwcc.ms.gov/pdf/mwccGuidlinesForThePrescriptionOfOpiates.pdf [File Link
				Not Available] .
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PHARMACY RULES › Section 20-2-IV - REIMBURSEMENT

Current through June 25, 2024
A. Reimbursement for pharmaceuticals ordered
				for the treatment of work-related injury/illness is as follows:
1. Brand/Trade Name Medications: Average
				Wholesale Price (AWP) plus a five dollar ($5.00) dispensing fee.
2. Generic Medications: Average Wholesale
				Price (AWP) minus 5% plus a five dollar ($5.00) dispensing fee.
3. Over-the-counter medications are
				reimbursed at usual and customary rates.
4. Dispensing fees are payable only if the
				prescription is filled under the direct supervision of a registered pharmacist.
				If a physician dispenses medications from his/her office, a dispensing fee is
				not allowed.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PHARMACY RULES › Section 20-2-V - SPECIAL PRICING

Current through June 25, 2024
A.
Repackaged
				Medication:
If the only submitted National Drug Code (NDC) for the drug
				  product as dispensed is a repackaged drug NDC, the drug will not be reimbursed.
				  For repackaged drugs, providers shall submit both the NDC of the repackaged
				  drug dispensed and the NDC of the original manufacturer to receive properly
				  calculated reimbursement. Submission and placement of both NDCs shall be in
				  accordance with the specifications of the billing form/format being
				  used.
B.
Compound
				Medications:
A compound medication is any customized formulation of
				  medication prepared by a compounding pharmacist that is not commercially
				  available and which requires a prescription. All compounded medications shall
				  be billed by listing each individual component ingredient and each compound
				  ingredient's NDC as assigned by the original manufacturer and calculating the
				  charge for each component ingredient separately based on their AWP. Payment
				  shall be based on the sum of the AWP fee for each ingredient, plus a single
				  dispensing fee of five dollars ($5.00). Ingredients lacking an NDC will not be
				  reimbursed. Reimbursement for a compound topical medication is additionally
				  limited to a maximum total reimbursement of three hundred dollars ($300.00) for
				  a maximum of one hundred twenty (120) grams per month. A compound topical
				  medication provided in an amount less than one hundred twenty (120) grams per
				  month shall be prorated. Prior authorization (pre-certification) and medical
				  documentation is required for any additional quantity over and above this one
				  hundred twenty (120) grams per month amount.
C.
Combined Medications:
The
				entity packaging two or more products together must bill the products as
				individual line items identified by their original AWP and NDC. This original
				manufacturer NDC and its associated AWP shall be used to determine ingredient
				reimbursement. Supplies are considered integral to the package and not
				separately reimbursed.
D.
Other Special Pricing:
The maximum allowable reimbursement for
				manufactured topical medications other than patches is the billed charge up to
				a maximum of thirty dollars ($30.00) for a thirty (30) day supply, prorated if
				a lesser amount is provided. Patches will be reimbursed the billed charge up to
				a maximum of seventy dollars ($70.00) for a thirty (30) day supply, prorated if
				a lesser amount is provided. Intraarticular Joint Kits are limited to a maximum
				reimbursement of $27.36.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › OTHER QUALIFIED HEALTH CARE PROFESSIONAL RULES › Section 20-2-I - ANY QUALIFIED HEALTH CARE PROFESSIONAL

Current through June 25, 2024
Any qualified health care professional who is licensed in
				  Mississippi, practices within state guidelines, and is listed within this Fee
				  Schedule as an authorized provider is reimbursed for services based on this Fee
				  Schedule.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › OTHER QUALIFIED HEALTH CARE PROFESSIONAL RULES › Section 20-2-II - NURSE PRACTITIONER

Current through June 25, 2024
A. Modifier M1
				should be attached to the appropriate CPT code when billing services rendered
				by the nurse practitioner. The nurse practitioner must use his/her unique
				identifier to bill for all services. Nurse practitioners must comply with the
				requirements for a National Provider Identifier (NPI) as specified in the
				Billing and Reimbursement Rules of this Fee Schedule.
B. The nurse practitioner is reimbursed at
				eighty-five percent (85%) of the maximum allowable for the procedure.
C. There is only one fee allowed
				for each CPT code. It is the decision of the physician or the nurse
				practitioner as to who will bill for a service when both have shared in the
				provision of the service. Incorrect billing of the service may cause a delay or
				improper payment by the payer. The medical doctor (MD) must be on-site on the
				date of service and provide additional documentation and review of services in
				order for physician reimbursement to be applied.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › OTHER QUALIFIED HEALTH CARE PROFESSIONAL RULES › Section 20-2-III - PHYSICIAN ASSISTANT

Current through June 25, 2024
A.
				Mississippi-specific modifier M2 should be attached to the appropriate CPT
				code(s) when billing services rendered by the physician assistant.
B. The physician assistant is reimbursed at
				eighty-five percent (85%) of the maximum allowable for the procedure.
C. There is only one fee allowed
				for each CPT code. It is the decision of the physician or the physician
				assistant as to who will bill for a service when both have shared in the
				provision of the service. Incorrect billing of the service may cause a delay or
				improper payment by the payer. The medical doctor (MD) must be on-site on the
				date of service and provide additional documentation and review of services in
				order for physician reimbursement to be applied.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › OTHER QUALIFIED HEALTH CARE PROFESSIONAL RULES › Section 20-2-IV - PHYSICAL THERAPIST ASSISTANT OR OCCUPATIONAL THERAPIST ASSISTANT

Current through June 25, 2024
A. Mississippi-specific modifier M3 should be
				appended to the appropriate CPT code(s) when billing services rendered by a
				physical therapist assistant or an occupational therapist assistant.
B. The physical therapist assistant or
				occupational therapist assistant is reimbursed at eighty-five percent (85%) of
				the maximum allowable for the procedure.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › OTHER QUALIFIED HEALTH CARE PROFESSIONAL RULES › Section 20-2-V - PSYCHOLOGY

Current through June 25, 2024
When a provider other than a psychiatrist provides psychology
				  services, the reimbursement amount for the CPT code is paid at eighty-five
				  percent (85%) of the maximum allowable reimbursement. This applies to
				  psychologists, social workers, counselors, etc.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HOME HEALTH › Section 20-2-I - SCOPE

Current through June 25, 2024
This section of the Fee Schedule pertains to home health
				  services provided to patients who have a work-related injury/illness.
A. The determination that the injury/illness
				or condition is work related must be made by the payer and home health services
				shall be authorized as medically necessary.The determination that the
				injury/illness or condition is work related must be made by the payer and home
				health services shall be authorized as medically necessary.
B. All nursing services and personal care
				services shall have prior authorization by the payer.
C. A description of needed nursing or other
				attendant care must accompany the request for authorization.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HOME HEALTH › Section 20-2-II - REIMBURSEMENT

Current through June 25, 2024
A. If a payer and provider have a mutually
				agreed upon contractual arrangement governing the payment for home health
				services to injured/ill employees, the payer shall reimburse under the
				contractual agreement and not according to the Fee Schedule.
B. In the absence of a mutually agreed upon
				contractual arrangement governing payment for home health service,
				reimbursement shall be made as in other cases (see Billing and Reimbursement
				Rules) in an amount equal to billed charges, or the maximum allowable
				reimbursement (MAR), whichever is less. Billing for home health services is
				appropriate using the applicable billing form for other institutional providers
				or facilities.
C. A visit made
				simultaneously by two or more workers from a home health agency to provide a
				single covered service for which one supervises or instructs the other shall be
				counted as one visit.
D. A visit
				is defined as time up to and including the first two hours.
E. The maximum allowable reimbursement (MAR)
				listed herein are inclusive of mileage and other incidental travel expenses,
				unless otherwise agreed to by the payer and provider.
F. The rates set forth in this section of the
				Fee Schedule apply to all hours worked. No additional reimbursement is allowed
				for overtime hours, unless otherwise agreed to by the parties in a separate fee
				contract.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HOME HEALTH › Section 20-2-III - RATES

Current through June 25, 2024
A. The following MAR and codes apply to
				services provided by or through a home health agency:
Service
Fee Per Visit
Billing Code
RN Skilled Nursing
$125.00
S9123
LPN Skilled Nursing
$105.00
S9124
Physical Therapy
$125.00
S9131
Speech Therapy
$125.00
S9128
Occupational Therapy
$125.00
S9129
Medical Social Services
$125.00
S9127
Home Health Aide
$55.00
S9122
Note:
The descriptions of these
				codes have been modified for this Fee Schedule. Please see the HCPCS section.
For services that exceed two (2) hours, reimbursement for
				  time in excess of the first two (2) hours shall be pro-rated and based on an
				  hourly rate equal to fifty percent (50%) of the above visit fee. For home
				  health services rendered in two (2) hours or less, reimbursement shall be made
				  for a visit as above provided.
Note:
In addition to the Skilled Nursing Care
				  fees above, an additional sum of seven dollars and sixteen cents ($7.16) per
				  visit shall be added to cover the cost of medical supplies, provided the
				  billing form adequately specifies what supplies were utilized.
B. The following Private Duty Rates shall
				apply:
Skilled Nursing Care - R.N.
$44.00 per hour
Skilled Nursing Care - L.P.N.
$37.00 per hour
Certified Nurse Assistant
$20.00 per hour
Sitter/Attendant
$15.00 per hour
C.
				Any reimbursement to persons not working under a professional license, such as
				a spouse or relative, will be at the rate of eight dollars ($8.00) per hour
				unless otherwise negotiated by the payer and caregiver or provider.
D. Professional providers not assigned a MAR
				for home health services and who have not negotiated their rates with the payer
				prior to provision of home health care, shall be reimbursed at the usual and
				customary rate, or the total billed charge, whichever is less.
E. Respite Care is reimbursed at a rate of
				$20.00 per hour.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HOME HEALTH › Section 20-2-IV - PARENTERAL/ENTERAL/HOME INFUSION THERAPY IN THE HOME SETTING

Current through June 25, 2024
A. The MAR
				for this therapy provided in the home setting is a per diem amount and includes
				necessary supplies for the safe and effective administration of the prescribed
				therapy. Supplies include set(s), needles, syringes, saline, tubing, dressing
				kits, saline, heparin, alcohol pads, start kits, catheters, adapters, tape,
				gauges, pump, poles, and other supplies.
B. Per diem amounts are as follows:
Parenteral therapy/home infusion (with or without
				  antibiotics)
Daily - $165.00
Twice a day - $190.00
Three times a day - $215.00
Four times a day - $265.00
Five or more times a day - $335.00
Total Parental Nutrition (TPN):
1-1.6 Liters per day - $280.00
1.7-2.4 Liters per day - $350.00
More than 2.4 liters per day - $385.00
Lipids:
10% - $75.00
20% - $95.00
Enteral Therapy:
$24.00 per day
C. Medications for Parenteral/Enteral Therapy
				are reimbursed at AWP.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › HOME HEALTH › Section 20-2-V - HOSPICE

Current through June 25, 2024
A. Hospice reimbursement is a per diem amount
				that is all inclusive for services provided.
B. Daily per diem amounts are as follows:
Routine Home Care - $384.78
Continuous Home Rate - $1,995.56
Inpatient Care - $1,486.36
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-II - GENERAL GUIDELINES

Current through June 25, 2024
The E/M section is divided into broad categories such as
				  office visits, hospital visits, and consultations. Most of the categories are
				  further divided into two or more subcategories of E/M services. Keep the
				  following in mind when coding each service setting:
A. A patient is considered an outpatient at a
				health care facility until formal inpatient admission occurs.
B. All physicians use codes 99281-99285 for
				reporting emergency department services, regardless of hospital-based or
				non-hospital-based status.
C.
				Admission to a hospital or nursing facility includes E/M services provided
				elsewhere on the same day.
D. Not
				more than one hospital visit per day shall be payable except when documentation
				describes the medical necessity of more than one visit by a particular
				practitioner. Hospital visit codes shall be combined into the single code that
				best describes the service rendered.
E. Only one provider is reimbursed for a
				patient visit, except where wound care evaluation is provided in an established
				wound care center.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-III - OFFICE OR OTHER OUTPATIENT SERVICES (99201-99215)

Current through June 25, 2024
Use the Office or Other Outpatient Services codes to report
				  evaluation and management services provided in the office or in an outpatient
				  or other ambulatory facility. A patient is considered an outpatient until
				  inpatient admission to a health care facility occurs.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-IV - HOSPITAL OBSERVATION SERVICES (99217-99226)

Current through June 25, 2024
CPT codes 99217 through 99226 report E/M services provided to
				  patients designated as "observation status" in a hospital. It is not necessary
				  that the patient be located in an observation area designated by the
				  hospital.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-V - OBSERVATION CARE DISCHARGE SERVICES (99217)

Current through June 25, 2024
A. CPT code 99217
				is used only if discharge from observation status occurs on a date other than
				the initial date of observation. The code includes final examination of the
				patient, discussion of the hospital stay, instructions for continuing care, and
				preparation of discharge records.
B. If a patient is admitted to and
				subsequently discharged from observation status on the same date, see codes
				99234-99236 as appropriate.
C. Do
				not report observation care discharge CPT code 99217 in conjunction with a
				hospital admission.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-VI - HOSPITAL INPATIENT SERVICES (99221-99239)

Current through June 25, 2024
Codes 99221-99239 are used to report evaluation and
				  management services provided to hospital inpatients. Hospital inpatient
				  services include those services provided to patients in a "partial hospital"
				  setting. These codes are to be used to report these partial hospitalization
				  services.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-VII - CONSULTATIONS (99241-99255)

Current through June 25, 2024
A consultation is a type of evaluation and management service
				  provided at the request of another physician or appropriate source to either
				  recommend care for a specific condition or problem or to determine whether to
				  accept responsibility for ongoing management of the patient's entire care or
				  for the care of a specific condition or problem.
A physician consultant may initiate diagnostic and/or
				  therapeutic services at the same or subsequent visit.
A "consultation" initiated by a patient and/or family, and
				  not requested by a physician or other appropriate source (eg, physician
				  assistant, nurse practitioner, doctor of chiropractic, physical therapist,
				  occupational therapist, speech-language pathologist, psychologist, social
				  worker, lawyer, employer or insurance company), is not reported using the
				  consultation codes but may be reported using the office visit, home service, or
				  domiciliary/rest home care codes as appropriate.
The written or verbal request for consult may be made by a
				  physician or other appropriate source and documented in the patient's medical
				  record by either the consulting or requesting physician or appropriate source.
				  The consultant's opinion and any services that were ordered or performed must
				  also be documented in the patient's medical record and communicated by written
				  report to the requesting physician or other appropriate source.
If a consultation is mandated (eg, by a third-party payer)
				  modifier 32 should also be reported.
Any specifically identifiable procedure (ie, identified with
				  a specific CPT code) performed on or subsequent to the date of the initial
				  consultation should be reported separately.
If subsequent to the completion of a consultation the
				  consultant assumes responsibility for management of a portion or all of the
				  patient's condition(s), the appropriate Evaluation and Management services code
				  for the site of service should be reported. In the hospital or nursing facility
				  setting, the consultant should use the appropriate inpatient consultation code
				  for the initial encounter and then subsequent hospital or nursing facility care
				  codes. In the office setting, the consultant should use the appropriate office
				  or other outpatient consultation codes and then the established patient office
				  or other outpatient services codes.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-VIII - EMERGENCY DEPARTMENT SERVICES (99281-99288)

Current through June 25, 2024
Emergency department (ED) service codes do not differentiate
				  between new and established patients and are used by hospital-based and
				  non-hospital-based physicians. An emergency department is defined as "an
				  organized hospital-based facility for the provision of unscheduled episodic
				  services to patients who present for immediate medical attention. The facility
				  must be available 24 hours a day." This guideline indicates that care provided
				  in the ED setting for convenience should not be coded as an ED service. Also
				  note that more than one ED service can be reported per calendar day if
				  medically necessary.
Codes 99281-99288 are used to report services provided in a
				  medical emergency. If, however, the physician sees the patient in the emergency
				  room out of convenience for either the patient or physician, the appropriate
				  office visit code should be reported (99201-99215) and reimbursement will be
				  made accordingly.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-X - NURSING FACILITY SERVICES (99304-99318)

Current through June 25, 2024
Codes 99304-99318 are used to report evaluation and
				  management services to patients in nursing facilities (skilled nursing
				  facilities (SNFs)) intermediate care facilities (ICFs), or long-term care
				  facilities (LTCFs).
These codes should also be used to report evaluation and
				  management services provided to a patient in a psychiatric residential
				  treatment center (a facility or a distinct part of a facility for psychiatric
				  care, which provides a 24-hour therapeutically planned and professionally
				  staffed group living and learning environment). If procedures such as a medical
				  psychotherapy are provided in addition to evaluation and management services,
				  these should be reported in addition to the evaluation and management services
				  provided.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XI - DOMICILIARY, REST HOME (E.G., BOARDING HOME), OR CUSTODIAL CARE SERVICES (99324-99340)

Current through June 25, 2024
The evaluation and management codes are used to report
				  evaluation and management services in a facility that provides room, board, and
				  other personal assistance services generally on a long-term basis. They also
				  are used to report evaluation and management services in an assisted living
				  facility.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XIII - PROLONGED SERVICES (99354-99359, 99415-99416)

Current through June 25, 2024
Codes 99354-99357 are used when a physician or other
				  qualified health care professional provides prolonged service involving direct
				  patient contact that is provided beyond the usual service in either the
				  inpatient or outpatient setting. Codes 99358-99359 are used when a physician or
				  other qualified health care professional provides prolonged service for patient
				  management where face-to-face services have or will occur on another date of
				  service.
Codes 99415-99416 are used when a physician or other
				  qualified health care professional provides prolonged service involving direct
				  patient contact that is provided beyond the usual service in either an office
				  or outpatient setting.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XIV - PHYSICIAN STANDBY SERVICES (99360)

Current through June 25, 2024
Code 99360 is used to report physician or other qualified
				  health care professional standby service that is requested by another
				  individual and that involves prolonged attendance without direct (face-to-face)
				  patient contact. Care or services may not be provided to other patients during
				  this period. This code is not used to report time spent proctoring another
				  individual. It is also not used if the period of standby ends with the
				  performance of a procedure subject to a "surgical" package by the individual
				  who was on standby.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XV - CASE MANAGEMENT SERVICES (99366-99368, 9936M)

Current through June 25, 2024
Case management is a process in which a physician or other
				  qualified health care professional is responsible for direct care of a patient,
				  and, additionally, for coordinating, managing access to, initiating, and/or
				  supervising other health care services needed by the patient.
Mississippi guideline: Use state-specific code 9936M
				  for a conference with workers' compensation medical case manager/claims
				  manager.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XVI - CARE PLAN OVERSIGHT SERVICES (99374-99380)

Current through June 25, 2024
Care plan oversight services are reported separately from
				  codes for office/outpatient, hospital, home, nursing facility, domiciliary, or
				  non-face-to-face services. The complexity and the approximate time of the care
				  plan oversight services provided within a thirty (30) day period determine code
				  selection.
Only one individual may report care plan oversight services
				  for a given period of time, to reflect the sole or predominant supervisory role
				  with a particular patient. These codes should not be used for supervision of
				  patients in nursing facilities or under the care of home health agencies unless
				  they require recurrent supervision of therapy.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XVII - NON-FACE-TO-FACE SERVICES (99441-99449, 99451-99454, 99091, 99457)

Current through June 25, 2024
These codes are used to report non face-to-face evaluation
				  and management services using the telephone or internet resources and for
				  remote physiologic monitoring and treatment management
				  services.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XIX - CARE MANAGEMENT SERVICES (99487-99489)

Current through June 25, 2024
Care management services are management and support services
				  provided by clinical staff, under the direction of or provided personally by a
				  physician or other qualified health care professional. Services include
				  establishing, implementing, revising, or monitoring the care plan, coordinating
				  the care of other professionals and agencies, and educating the patient or
				  caregiver about the patient's condition, care plan, and prognosis. The
				  physician or other qualified health care professional provides or oversees the
				  management and/or coordination of services, as needed, for all medical
				  conditions, psychosocial needs, and activities of daily
				  living.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XX - PSYCHIATRIC COLLABORATIVE CARE MANAGEMENT (99492-99494)

Current through June 25, 2024
Psychiatric collaborative care services are provided under
				  the direction of a treating physician or other qualified health care
				  professional. These include the services of the treating physician or other
				  qualified health care professional, the behavioral health care manager and the
				  psychiatric consultant. Patients typically have behavioral health signs and/or
				  symptoms or a newly diagnosed behavioral health condition, may need help in
				  engaging in treatment, have not responded to standard care delivered in a
				  non-psychiatric setting, or require further assessment and engagement, prior to
				  consideration of referral to a psychiatric care setting.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XXI - TRANSITIONAL CARE MANAGEMENT (99495-99496)

Current through June 25, 2024
Transitional care management services are for a new or
				  established patient whosed medical and/or psychosocial problems require
				  moderate or high complexity medical decision making during transitions in care
				  from an inpatient hospital setting, partial hospital or observation status in a
				  hospital, or skilled nursing facility/nursing facility to the patient's
				  community setting.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › EVALUATION AND MANAGEMENT › Section 20-2-XXII - ADVANCE CARE PLANNING (99497-99498)

Current through June 25, 2024
These face-to-face services between a physician or other
				  qualified health care professional and a patient, family member, or surrogate
				  involving couseling and discussing advance directives with or without
				  completing relevant legal forms.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-I - INTRODUCTION

Current through June 25, 2024
The 2019 American Society of Anesthesiologists' (ASA)
				  Relative Value Guide® is recognized as an appropriate assessment of current
				  relative values for specific anesthesiology procedures. It is the basis for the
				  assigned base units for CPT codes in the Anesthesia section of the Fee
				  Schedule.
The conversion factor for anesthesia services has been
				  designated at $50.00 per unit.
Total anesthesia value is defined in the following
				  formula:
(Base units + time units + modifying units) x conversion
				  factor = reimbursement
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-II - BASE UNITS

Current through June 25, 2024
Base units are listed for most procedures. This value is
				  determined by the complexity of the service and includes all usual anesthesia
				  services except the time actively spent in anesthesia care and the modifying
				  factors. The base units include preoperative and postoperative visits, the
				  administration of fluids and/or blood incident to the anesthesia care, and
				  interpretation of non-invasive monitoring (ECG, temperature, blood pressure,
				  oximetry, and other usual monitoring procedures). The basic anesthesia unit
				  includes the routine follow-up care and observation (including recovery room
				  observation and monitoring). When multiple surgical procedures are performed
				  during the same period of anesthesia, only the highest base unit allowance of
				  the various surgical procedures will be used.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-III - TIME UNITS

Current through June 25, 2024
Anesthesia time begins when the anesthesiologist starts the
				  preparation of the patient for anesthesia in the preoperative area, the
				  operating room or a similar area, and ends when the injured employee is placed
				  under postoperative care, such as transfer to the recovery room.
The anesthesia time units will be calculated in 15-minute
				  intervals, or portions thereof, equaling one (1) time unit. No additional time
				  units are allowed for recovery room time and monitoring.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-IV - SPECIAL CIRCUMSTANCES

Current through June 25, 2024
A.
Physical
				Status Modifiers.
Physical status modifiers are represented by the
				initial letter P followed by a single digit from one (1) to six (6) defined
				below:
Status
Description
Base Units
P1
A normal healthy patient
0
P2
A patient with mild systemic disease
0
P3
A patient with severe systemic disease
1
P4
A patient with severe systemic disease that is a
							 constant threat to life
2
P5
A moribund patient who is not expected to survive
							 without the operation
3
P6
A patient declared brain-dead whose organs are being
							 removed for donor purposes
0
These six levels are consistent with the American Society of
				  Anesthesiologists' (ASA) ranking of patient physical status. Physical status is
				  included in CPT to distinguish between various levels of complexity of the
				  anesthesia service provided. Documentation submitted with the billing must
				  include the indicators that justify physical status for P3, P4, and P5.
I.
Qualifying
				Circumstances
1. Many anesthesia
				services are provided under particularly difficult circumstances, depending on
				factors such as extraordinary condition of patient, notable operative
				condition, and/or unusual risk factors. These procedures would not be reported
				alone but would be reported as additional procedure numbers qualifying an
				anesthesia procedure or service.
CPT Code
Description
Units
99100
Anesthesia for patient of extreme age, younger than 1
							 year and older than 70 (List separately in addition to code for primary
							 anesthesia procedure)
1
99116
Anesthesia complicated by utilization of total body
							 hypothermia (List separately in addition to code for primary anesthesia
							 procedure)
5
99135
Anesthesia complicated by utilization of controlled
							 hypotension (List separately in addition to code for primary anesthesia
							 procedure) Mississippi guideline: Documentation must include maintaining BP at
							 100 for one hour or more.
5
99140
Anesthesia complicated by emergency conditions
							 (specify) (List separately in addition to code for primary anesthesia
							 procedure)
2
2.
				Payers must utilize their medical consultants when there is a question
				regarding modifiers and/or special circumstances for anesthesia
				charges.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-V - MONITORED ANESTHESIA CARE

Current through June 25, 2024
Monitored anesthesia care occurs when the attending physician
				  requests that an anesthesiologist be present during a procedure. This may be to
				  ensure compliance with accepted procedures of the facility. Monitored
				  anesthesia care includes pre-anesthesia exam and evaluation of the patient. The
				  anesthesiologist must participate or provide medical direction for the plan of
				  care. The anesthesiologist, resident, or nurse anesthetist must be in
				  continuous physical presence and provide diagnosis and treatment of
				  emergencies. This will also include non-invasive monitoring of
				  cardiocirculatory and respiratory systems with administration of oxygen and/or
				  intravenous administration of medications. Reimbursement will be the same as if
				  general anesthesia had been administered (time units + base
				  units).
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › ANESTHESIA › Section 20-2-VI - REIMBURSEMENT FOR ANESTHESIA SERVICES

Current through June 25, 2024
A.
Criteria
				for Reimbursement.
Anesthesia services may be billed for any one of the
				three following circumstances:
1. An
				anesthesiologist provides total and individual anesthesia service.
2. An anesthesiologist directs a Certified
				Registered Nurse Anesthetist (CRNA).
3. Anesthesia provided by a CRNA working
				independent of an anesthesiologist's supervision is covered under the following
				conditions:
a. The service falls within the
				CRNA's scope of practice and scope of license as defined by law.
b. The service is supervised by a licensed
				health care provider who has prescriptive authority in accordance with the
				clinical privileges individually granted by the hospital or other health care
				organization.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-I - INTRODUCTION

Current through June 25, 2024
A. Providers must restrict treatment to
				indications recognized by established medical practice that are adequately
				supported by the relevant medical literature.
B. Providers must demonstrate the
				effectiveness of previously provided treatment in order to repeat or continue
				it. This includes the use of pain diagrams and numerical pain scores where
				appropriate.
C. Payers and
				utilization review professionals must approve or deny treatment based on the
				rules within this section of the Fee Schedule without regard to external
				guidelines.
D. When denying care,
				the specific section of this Fee Schedule must be cited as the basis for
				denial. All denials must provide the rationale or the treatment will be
				approved.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-III - REIMBURSEMENT FOR REFILL OF PAIN PUMPS

Current through June 25, 2024
A.
Code
				95990.
This CPT code, which applies to refilling and maintenance of an
				implantable pump or reservoir for drug delivery spinal (intrathecal, epidural)
				or brain (intraventricular), is reimbursed at the specified MRA listed in the
				Medicine section of the Fee Schedule.
B.
Evaluation and Management
				Services.
Refilling and maintenance of implantable pump or reservoir for
				pain management drug delivery is a global service. A separate evaluation and
				management service is not paid unless significant additional or other cognitive
				services are provided and documented. To report a significant, separately
				identifiable evaluation and management service, append modifier 25 to the
				appropriate evaluation and management code. Documentation is required and
				payment will be allowed if supported by the documentation.
C.
Drugs.
Those drugs used in
				the refill of the pain pump shall be reimbursed in accordance with the Pharmacy
				Rules contained in the Pharmacy Rules section of this Fee Schedule.
D.
Compounding Fee.
If the drugs
				used in the refill of the pain pump must be compounded, the compounding service
				shall be reimbursed at $157.44 per individual refill. Report the compounding
				service with code S9430, Pharmacy compounding and dispensing services.
E. Non-FDA-approved drugs for
				intrathecal use will NOT be reimbursed.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-IV - DIAGNOSTIC INJECTIONS AND PROCEDURES

Current through June 25, 2024
A.
Radiofrequency Medial Branch Neurotomy/Facet Rhizotomy.
This
				procedure may be reimbursed not to exceed three (3) contiguous spinal joint
				levels during the same session/procedure. If there has been improvement with a
				prior successful radiofrequency (RF) denervation, then a minimum time of six
				(6) months should elapse since prior RF denervation treatment in order to
				qualify for a repeat procedure. No more than two (2) RF denervations may be
				reimbursed in the first twelve (12) months and one (1) per year
				thereafter.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-V - THERAPEUTIC SERVICES

Current through June 25, 2024
In the pain management setting, no more than two (2)
				  modalities and/or procedures may be used on a date of service (e.g., heat/cold,
				  ultrasound, diathermy, iontophoresis, TENS, electrical stimulation, muscle
				  stimulation, etc.). Multiple modalities should be performed sequentially. Only
				  one (1) modality can be reported for concurrently performed
				  procedures.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-VI - GENERAL RULES

Current through June 25, 2024
A.. Reimbursement
				will be limited to three (3) epidural pain injections in a twelve (12) month
				period unless the payer provides prior approval for more than three (3) such
				injections. Separate billing for the drug injected will not be reimbursed.
B.
Trigger Point
				Injections.
Trigger point (also called myofascial or myoneural)
				injections are reimbursed as one (1) procedure regardless of the number of
				injection sites. Multiple injections, and multiple regions will be reimbursed
				asone procedure. Report CPT 20552 for injection(s) single or multiple trigger
				point(s), one or two muscles, or 20553, injection(s), single or multiple
				trigger point(s), three or more muscles, Only one of these procedure codes will
				be reimbursed per date of service.
C.
Investigational Procedures.
Refer to the General Rules section.
D.
Sacroiliac (SI) Joint.
Therapeutic and diagnostic sacroiliac joint injections require the use of image
				guidance. Injections performed without imaging guidance, should be billed, and
				will be reimbursed, as a trigger point injection. CPT code 27096 requires the
				use of imaging confirmation of intra-articular needle positioning.
Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-VII - PAIN MANAGEMENT CRITERIA

Current through June 25, 2024
A. All
				Interventional Pain Management (IPM) procedures must be billed with the
				appropriate CPT codes and modifiers (where applicable) using accepted ICD-10-CM
				codes as the indications for the procedures. Providers MUST use acceptable
				codes in order to initiate or maintain treatment. Failure to do so is cause for
				denial of treatment until the proper appropriate codes are submitted.
Payers/URs must use the rules of this Fee Schedule to deny
				  requested treatment. Failure to cite the specific section of the IPM portion of
				  the Mississippi Workers' Compensation Medical Fee Schedule will result in
				  automatic adjudication for the provider without appeal. "Specific" refers to
				  citing the actual section, and appropriate subsections directly from the
				  guidelines. Failure to have the Fee Schedule available during the review would
				  make such citation unachievable, resulting in automatic adjudication for the
				  provider.
No outside guidelines can be used to deny IPM care requested in
				  accordance with the Fee Schedule.
B.
Injection/Destruction
				Procedures
Multiple Epidural Injections in a Single Treatment
				Day/Session. Reimbursement is limited to one epidural injection in a single
				treatment day/session, unless appropriate documentation is entered into the
				medical record of a medical condition for which multiple injections would be
				appropriate. These conditions include:
1.
				Disc pathology (e.g., protrusion) at one level with a dermatomal pain
				distribution of an adjacent level (e.g., disc affects the traversing nerve
				root, such as an L4/5 disc herniation affecting the traversing L5 nerve root).
2. Multiple dermatomal nerve root
				involvement.
3. Bilateral
				radicular pain.