Interpretive Policy Update

Certification: Page 131: Effective January 1, 2009 L&I will stop accepting provisional certification for interpreters. Any existing provisional certifications will be allowed to expire and the interpreter will be removed from active status.

Mileage Documentation page 139: Effective January 1, 2009 odometer readings will no longer be accepted for mileage documentation for interpreters. A printout from a software mileage program and name of software program must be used for documenting actual mileage.

Residential Services Coverage and Payment Policy changes  

The following CPT® codes are covered effective January 1, 2009 with the maximum fees listed.

DME & Home Health providers only: Effective May 1, 2009 the fees paid for disposable pumps will change.

A4305: Disposable drug delivery system, flow rate of 50 ml or greater per hour
Facility Fee: $32.35
Non Facility Fee $32.35

A4306: Disposable drug delivery system, flow rate of less than 50 ml per hour
Facility Fee: $96.65
Non-Facility Fee: $96.65

Fee's for the following CPT® codes are being updated based on RVU changes from CMS.

Under Credentials Required for L&I Provider Account

Interpreters and translators can only be paid for services in the languages for which they have provided credentials.

Under Payment Methods for Spinal Injection Procedures on page 48 of the Payment Policies the payment method for radiology procedures performed in an ASC was inadvertently listed as the technical portion of the fee schedule.

The correct payment method for radiology procedures performed in an ASC is the ASC Fee Schedule. The fees may no longer be based on the technical component of the professional services fee schedule.

1108M IME, standard exam – 1-3 body areas or organ systems

• Diagnostic tests needed are ordered and interpreted.
• Impairment rating is performed if requested.

1129M IME, extensive file review by examiner

• Bill for each additional page beyond the first 550 hardcopy pages
  • Review of the first 550 hardcopy pages is included in the base exam fee (1108M, 1109M, 1118M or 1130M).
  • Not Payable with 1111M or 1120M
• Units of service are based on the number of hardcopy pages contained on microfiche, paper, Claim and Account Center or other medium.
  • Only the following document categories contained in the Claim and Account Center will be paid for file review unless the authorizing letter requests a review of ALL documents:
    • Medical Provider
    • Voc Rehab Provider
    • History
    • Report of Accident
    • Re-open Application
• Bill per examiner.
• To be eligible for payment a detailed chronology of the injury or condition must be included in the report as defined by the Medical Examiners’ Handbook.

The entry should read:
1131M IME out of state exam:

• Bill for all services including activities occurring after the IME exam, such as addendums
  • Except record handling codes [1100M, 1101M, 1132M and 1133M] which are not payable by self insured
  • Also, Except the CPT® codes for neuropsychological evaluation and testing.
    • Bill the above items separately
  • Combine all 1131M charges into one line-item.

  L&I and self insurers will pay 1131M based upon the report submitted. (See the definition of "By report" in WAC 296-20-01002)

Additional entries:

Maintenance of Role Boundaries [page 140]

• Interpreters must not engage in any other activities that may be thought of as a service other than interpreting, such as
  • Driving the insured to and from appointments
  • Suggesting that the claimant receive care at certain providers
  • Advocating for the claimant

Prohibited Conduct [page 141]

• Arrange appointments
  • To create business of any kind
  • To fit into your schedule including canceling and rescheduling a claimant's medical appointment

The following HCPCS codes are incorrectly listed as covered in the Professional and ASC fee schedules.

• C1715.
• C1717.