Michael F. Easley, Governor
Buck Lattimore, Chairman

Christine Williams
Chief Medical Fee Examiner
Medical Fees Section
Office: (919) 807-2614
williamc@ind.commerce.state.nc.us

Bernadine S. Ballance, Commissioner
Laura K. Mavretic, Commissioner
Danny Lee McDonald, Commissioner
Christopher Scott, Commissioner
Dianne C. Sellers, Commissioner
Pamela T. Young, Commissioner

North Carolina
Industrial Commission

 

MEMORANDUM

 

TO:

All Interested Parties

FROM:

Christine Williams, Chief Medical Fee Examiner

DATE:

February 14, 2007

RE: 2007 CPT Code Update to the Workers’ Compensation Medical Fee Schedule
 

The American Medical Association has released its 2007 Current Procedural Terminology (CPT Codes). As a result, the North Carolina Industrial Commission is publishing the attached fees for these CPT Codes on our website at http://www.ic.nc.gov/ncic/pages/commcode.htm, effective January 1, 2007. We also have deleted the codes that the American Medical Association no longer recognizes. Effective January 1, 2007, providers may no longer use the deleted codes for billing purposes. Please see our website at http://www.ic.nc.gov/ncic/pages/feesec13.htm for the 2007-2008 updates to the Dental Fee Schedule. In addition the new mileage rate for trips taken on or after January 1, 2007, for medical treatment in workers’ compensation cases is $0.485 a mile, provided the roundtrip is 20 miles or more. You may access the new form by clicking here: http://www.ic.nc.gov/ncic/pages/form25t.pdf

The Commission requires all healthcare providers which include individuals, such as physicians, dentists, and pharmacists, and organizations, such as hospitals, nursing homes, home health agencies, pharmacies, and group practices to submit medical bills using the new UB-04 and CMS 1500 forms along with the newly implemented National Provider Identifier (NPI) and Taxonomy code sets. The National Uniform Billing Committee (NUBC) approved the UB-04 as the replacement for the UB-92. Starting May 23, 2007, all institutional paper claims must be submitted on the UB-04. The UB-92 will no longer be acceptable, even as an adjusted claims, after May 22, 2007. The National Uniform Claim Committee (NUCC) revised the CMS-1500 in 2006; the new version, CMS-1500 (08-05), will replace the current CMS-1500 (12-90) version effective April 1, 2007. CMS will discontinue acceptance of 12-90 version of the CMS-1500 form on April 1, 2007 as will the Commission. These new forms will incorporate the new NPI and taxonomy code sets. As outlined in the Federal Regulation, the National Provider Identifier (NPI) is a 10-position numeric identifier, with a check digit in the 10th position, and no intelligence about the health care provider in the number. A health care provider must comply with the implementation specifications in § 162.410 for the new NPI no later than May 23, 2007. In addition, The National Uniform Claim Committee (NUCC) released updates to the Health Care Provider Taxonomy Code List that became effective on April 1, 2006. Additional information concerning these mandatory changes can be located by clicking on the following links:

UB-04: http://www.cms.hhs.gov/Transmittals/downloads/R1104CP.pdf

CMS 1500: http://www.nucc.org/images/stories/PDF/claim_form_manual_v2-0_1-07.pdf

NPI: http://www.cms.hhs.gov/NationalProvIdentStand/

Taxonomy: http://www.nucc.org/content/view/26/0/

Thank you in advance for your anticipated cooperation in instituting these mandatory changes.


North Carolina Industrial Commission ·   Medical Fees Section
4337 Mail Service Center ·   Raleigh, NC 27699-4337
Main Telephone: (919) 807-2503 ·   Fax: (919) 715-0282
NCIC Home Page: http://www.ic.nc.gov/