Fee Schedule Updates
Future fee schedule updates for services provided by HealthChoice Network Providers are scheduled for:
- Jan. 1: Add, change and delete codes for CPT/HCPCS, OP, ASC, and ADA
- Jan. 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, Select, and ADA
- Feb. 1: Add, change and delete codes for ASA
- April 1: Comprehensive fee schedule update for CPT/HCPCS, OP, ASC, Select, and ADA
- July 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, Select, and ADA
- Oct. 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, Select, and ADA
- Oct. 1: Comprehensive fee schedule update for MS-DRG and MS-DRG LTCH
As a reminder, national medical and dental associations may change, add, correct or delete billing codes throughout the year. When these modifications occur, EGID reviews them as quickly as possible and makes any necessary updates. Additionally, EGID performs fee schedule updates on an ad hoc basis when necessary.
Inpatient and outpatient tier designations and urban/rural statuses are updated on Oct. 1 each year, based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for Network Providers.
Inpatient and outpatient tier designations are defined as:
Tier 1 – Network urban facilities with greater than 300 beds
Tier 2 – All other urban and non-Network facilities
Tier 3 – Critical access hospitals, sole community hospitals, and Indian, military and VA facilities
Tier 4 – All other Network rural facilities
Following each quarterly update of the HealthChoice fee schedule, outpatient rates for the procedures covered under the program will become fully phased in during the next quarterly update.
Fee schedule updates are reported in each quarterly issue of the Network News newsletter. If you need specific codes and Allowable Fees affected by these updates, please visit our website at
https://gateway.sib.ok.gov/feeschedule and view or download the latest fee schedule addendum. The fee schedule has not been publicly disclosed and is deemed confidential pursuant to 51 O.S. and should not be disseminated, distributed or copied to persons not authorized to receive the information. If you have questions or need additional information, please contact network management.
The following terms are used in the fee schedule:
- BR: By Report
- BR1: 60% of billed charges for Tiers 1 and 2; 70% of billed charges for Tiers 3 and 4
- BR2: 30% of billed charges for Tiers 1 and 2; 35% of billed charges for Tiers 3 and 4
- BR3: 25% of billed charges for Tiers 1, 2, 3 and 4
Health: Submit to Health Plan
IC: Individual Consideration
NOC: Non-Classified Drugs, etc.
Per Diem: Per Diem Rate
RX: Submit to Pharmacy Administrator
TM: Use of Time
- Physician Assistant, Nurse Practitioner and Clinical Specialist is 85% of fee allowable.
- Anesthesia Conversion Factors
- $50 CRNA
- $55 M.D./D.O.
- Anesthesia Assistant is 50% of fee allowable.