Fee Schedule Updates
Posted 04/03/2014; Updated 11/13/2015
HealthChoice and the Department of Corrections (DOC) provide fee schedule updates on January 1 each year that reflect added, changed, and deleted codes; however, the comprehensive annual fee schedule update occurs on April 1 of each year. This allows time for the Centers for Medicare & Medicaid Services (CMS) to finalize and post its fee schedules.
The following dates have been set for all future fee schedule updates for services provided by HealthChoice and DOC Network Providers:
January 1: Add, change, and 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 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, MS-DRG LTCH and inpatient and outpatient tier designations
As a reminder, the American Medical Association periodically changes, adds, corrects or deletes procedure codes throughout the year. When these modifications occur, HealthChoice and DOC review them as soon as possible and make any necessary changes. Additionally, the Office of Management and Enterprise Services Employees Group Insurance Department makes fee schedule updates on an ad hoc basis when necessary.
Inpatient tier designations and outpatient urban/rural statuses are updated on October 1 each year, based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for Network Providers.
Fee schedule updates are reported in each issue of the Network News 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 have questions, please contact Network Management by calling 1-405-717-8790 or toll-free 1-844-804-2642. Inquiries by email should be sent to EGID.NetworkManagement@omes.ok.gov.