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24.29.1538    CONVERSION FACTORS FOR SERVICES PROVIDED ON OR AFTER JANUARY 1, 2008

(1) This rule applies to services, supplies, and equipment provided on or after January 1, 2008.

(2) The conversion factors established by the department for goods and services, other than anesthesia services are:

(a) $63.45 from January 1, 2008, through December 31, 2008;

(b) $65.28 from January 1, 2009, through June 30, 2013;

(c) $60.52 from July 1, 2013, through June 30, 2014;

(d) $59.72 from July 1, 2014, through June 30, 2015;

(e) $61.49 from July 1, 2015, through June 30, 2016;

(f) $62.91 from July 1, 2016, through June 30, 2017;

(g) $62.92 from July 1, 2017, through June 30, 2018;

(h) $63.50 from July 1, 2018, through June 30, 2019;

(i) $64.04 from July 1, 2019, through June 30, 2020;

(j) $63.41 from July 1, 2020, through June 30, 2021; and

(k) $61.05 on or after July 1, 2021.

(3) The conversion factors established by the department for anesthesia services are:

(a) $57.20 from January 1, 2008, through December 31, 2008;

(b) $61.98 from January 1, 2009, through December 31, 2009;

(c) $60.97 from January 1, 2010, through June 30, 2013;

(d) $61.40 from July 1, 2013, through June 30, 2014;

(e) $62.98 from July 1, 2014, through June 30, 2015;

(f) $65.63 from July 1, 2015, through June 30, 2016;

(g) $63.86 from July 1, 2016, through June 30, 2017;

(h) $65.98 from July 1, 2017, through June 30, 2018;

(i) $66.97 from July 1, 2018, through June 30, 2019;

(j) $69.58 from July 1, 2019, through June 30, 2020;

(k) $67.32 from July 1, 2020, through June 30, 2021; and

(l) $64.84 on or after July 1, 2021.

(4) Up to the top five insurers or third-party administrators, ranked by premiums written in Montana providing group health insurance coverage through a group health plan as defined in 33-22-140, MCA, and who use the RBRVS to determine fees for covered services, must annually provide to the department their current standard conversion factors by July 1.

(5) The conversion factor amounts for professional services are calculated using the average rates for medical services paid by up to the top five insurers or third-party administrators providing group health insurance via a group health plan in Montana, based upon the amount of premium for that category of insurance reported to the office of the Montana insurance commissioner. The term "group health plan" has the same meaning as provided by 33-22-140, MCA. To be included in the conversion factor determination, the insurer or third-party administrator must occupy at least one percent of the market share for group health insurance policies as reported annually to the insurance commissioner.

(a) The department annually surveys up to the top five insurers to collect information on the rates (the RBRVS conversion factors) paid during the current year for professional health care services furnished in Montana.

(b) The department's conversion factors for the following year are set at no more than 110 percent of the surveyed average. 

 

History: 39-71-203, MCA; IMP, 39-71-704, MCA; NEW, 2007 MAR p. 1670, Eff. 10/26/07; AMD, 2009 MAR p. 8, Eff. 1/16/09; AMD, 2009 MAR p. 2482, Eff. 12/25/09; AMD, 2013 MAR p. 1185, Eff. 7/12/13; AMD, 2014 MAR p. 1513, Eff. 7/11/14; AMD, 2015 MAR p. 818, Eff. 6/26/15; AMD, 2016 MAR p. 1055, Eff. 6/18/16; AMD, 2017 MAR p. 784, Eff. 6/10/17; AMD, 2018 MAR p. 1036, Eff. 5/26/18; AMD, 2019 MAR p. 848, Eff. 6/22/19; AMD, 2020 MAR p. 1021, Eff. 6/13/20; AMD, 2021 MAR p. 716, Eff. 6/12/21.

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