R612-300-6. Limitations on Fees for Specific Medical Providers and Non-Physicians

  A. Physician Assistants, Nurse Practitioners, Medical Social Workers, Nurse Anesthetists, and Physical Therapy Assistants. Fees for services performed by physician assistants, nurse practitioners, medical social workers, nurse anesthetists, and physical therapy assistants are set at 75% of the amount that would otherwise be allowed by these rules and shall be billed using an 83 modifier.

  B. Assistant Surgeons. Fees for assistant surgeons are limited as follows:

  1. Medical doctors, osteopaths and podiatrists, designated with an -80 modifier, are to be paid 20% of the primary surgeon's fee;

  2. Minimum paramedicals, designated with an -81 modifier, are to be paid 15% of the primary surgeon's value or 75% of the amount allowed under subsection B. 1., above.

  3. When a qualified resident surgeon is not available, 20% of the primary surgeon's fee;

  4. Other paramedical assistants, such as surgical assistants, are not billed separately.

  C. Home health care. The following fees, which include mileage and travel time, are payable for Home Health Codes 99500 through 99602:

  1. RN: $100/ 2 hours

  2. LPN: $75 / 2 hours

  3. Home Health Aide: $25 / hour + $6 additional 30 min.

  4. Speech Therapists: $80 / visit

  5. Physical Therapy: $125/ hour

  6. Occupational Therapy: $125/ hour

  7. Home Infusion Providers are to be paid according to contract between the payor and home infusion provider. If no contract is established, the payor shall pay the amount specified in Days Guidelines and pay UCR or Cost + 15% for the drugs and supplies.

  D. Acupuncturists, naturopathic providers and massage therapy. Payor preauthorization is required for any services provided by acupuncturists and naturopaths. Payment for massage therapy is only allowed when administered by a medical provider and billed according to the requirements of Rule R612-300. 5. C, "Restorative Services."

  E. Ambulance. Ambulance charges are limited to the rates set by the State Emergency Medical Service Commission.