Fee Schedule Updates
HealthChoice and the Department of Corrections (DOC) provide fee schedule updates on Jan. 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:
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, ADA, and Select inpatient and outpatient fee schedules
Feb. 1: Add, change and delete codes for ASA
April 1: Comprehensive fee schedule update for CPT/HCPCS, OP, ASC, ADA, and Select inpatient and outpatient fee schedules
July 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, ADA, and Select inpatient and outpatient fee schedules
Oct. 1: Quarterly fee schedule addendum and other updates as necessary for CPT/HCPCS, OP, ASC, ASA, ADA, and Select inpatient and outpatient fee schedules
Oct. 1: Comprehensive fee schedule update for MS-DRG, MS-DRG LTCH, and inpatient and outpatient tier designations
As a reminder, associations periodically change, add, correct or delete 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 Division makes fee schedule updates on an ad hoc basis when necessary.
Inpatient and outpatient tier designations are updated on Oct. 1 of each year, based on the most current CMS fiscal year inpatient prospective payment system (IPPS) impact file for Network Providers. HealthChoice and DOC recognize counties designated by the U.S. Census Bureau as a part of a metropolitan core-based statistical area (CBSA) as urban.
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 and DOC Select 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 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 405-717-8790 or toll-free 844-804-2642. Inquiries by email should be sent to EGID.NetworkManagement@omes.ok.gov.