Mich. Admin. Code R. 418.101003 - Reimbursement for "by report" and ancillary procedures
Rule 1003.
(1)
If a procedure code does not have a listed relative value, or is noted BR, then
the carrier shall reimburse the provider's usual and customary charge or
reasonable payment, whichever is less, unless otherwise specified in these
rules.
(2) The following ancillary
services are by report and the provider shall be reimbursed either at the
practitioner's usual and customary charge or reasonable payment, whichever is
less:
(a) Dental services.
(b) Vision and prosthetic optical services.
(c) Hearing aid
services.
(d) Home health
services.
(3) Orthotic
and prosthetic procedures, L0000-L9999, shall be reimbursed by the carrier at
Medicare plus 5%. The health care services division shall provide maximum
allowable payments for L-code procedures separate from these rules on the
agency's website, www.michigan.gov/wca. Orthotic and
prosthetic procedures with no assigned maximum allowable payment shall be
considered by report procedures and require a written description accompanying
the charges on the CMS-1500 claim form. The report shall include date of
service, a description of the service or services provided, the time involved,
and the charge for materials and components.
Notes
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