(1) This rule applies to DME provided by a nonfacility on or after January 1, 2008.
(2) Except for prescription medicines as provided by ARM 24.29.1529, reimbursement for DME dispensed through a medical provider is calculated by using the RVU listed in the RBRVS times the conversion factor established in ARM 24.29.1538 in effect on the date of service. If a RVU is not listed or if the RVU is listed as null, reimbursement is limited to a total amount that is determined by adding the cost of the item plus the freight cost plus the lesser of either $30.00 or 30 percent of the cost of the item. An invoice documenting the cost of the equipment or supply must be sent to the insurer upon the insurer's request.
(a) Copies of the instructions are available on the department web site at http://erd.dli.mt.gov/work-comp-claims/medical-regulations
or may be obtained at no charge from the Montana Department of Labor and Industry, P.O. Box 8011, Helena, Montana 59604-8011.
(3) If a provider adds value to DME (such as by complex assembly, modification, or special fabrication), then the provider may charge a reasonable fee for those services. Merely unpacking an item is not a "value-added" service. While extensive fitting of devices may be billed for, simple fitting (such as adjusting the height of crutches) is not billable.
(4) This rule does not apply to:
(a) health care facilities;
(b) pharmacies; or
(c) equipment supply houses that are not also health care providers.