Fee Schedule Updates
Posted 1/27/12

For charges incurred on or after January 1, 2012, HealthChoice and the Department of Corrections (DOC) updated the following fee schedules:

• CPT/HCPCS*
• Outpatient Facilities (OP)*
• Ambulatory Surgery Centers (ASC)
• American Society of Anesthesiologists (ASA)
• American Dental Association (ADA)

HealthChoice and DOC provide fee schedule updates on January 1 of each year that reflect codes that have been added, changed, and/or deleted; however, providers should note that the comprehensive annual fee schedule update occurs on April 1 of each year. This date allows time for the Centers for Medicare & Medicaid Services (CMS) to finalize and post its fee schedules.

Following is the 2012 schedule for HealthChoice and DOC fee schedule updates:

• January 1: Add, change, and/or delete codes for CPT/HCPCS, OP, ASC, and ADA
• January 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, and ADA
• February 1: Add, change, and/or delete codes for ASA
• April 1: Comprehensive fee schedule update for CPT/HCPCS, OP, ASC, and ADA
• July 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, and ADA
• October 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, and ADA
• October 1: Comprehensive fee schedule update for MS-DRG and MS-DRG LTCH

As a reminder, the American Medical Association periodically changes, adds, corrects, and/or deletes procedure codes throughout the year. When these changes occur, HealthChoice and DOC review them as soon as possible and make any necessary changes. Additionally, OSEEGIB makes fee schedule updates on an ad hoc basis when necessary.

Fee schedule updates are reported in each issue of the Network News newsletter which is distributed quarterly to all Network Providers. Updates are also posted to the provider websites. We encourage you and your staff to reference the website of your provider network for the most recent fee schedule updates and other important information.

If you want specific codes and Allowed Charges affected by these updates or if you have questions, please contact the Network Management/Provider Relations Division at 1-405-717-8790 or toll-free 1-800-543-6044.

Email inquiries can be sent to oseegibproviderrelations@sib.ok.gov.

*Exceptions that affect CPT, HCPCS, and Outpatient fee schedules: there are approximately 100 new CPT codes in the pathology code range (80000) related to gene testing. These codes are not covered.