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Select Types of Procedures and Fee Schedule
In the Select fee schedule, payments for Select bundled services are organized by “Types of Procedures.” Under the types of procedures are groups of similar services. For example, the arthroscopy bundle includes arthroscopy of the shoulder, arthroscopy of the elbow, arthroscopy of the wrist, etc., each of which has a separate and distinct CPT/HCPCS code.
EGID will be adding new bundles, as well as additional services to existing bundles, on an ongoing basis. Additional CPT/HCPCS codes and related pricing may also be added to any existing bundle with a future effective date.
Updated pricing will be published via the HealthChoice quarterly fee schedule addendum. Participating facilities should review the fee schedule addendum to identify new bundles and additional services being added to existing bundles. Quarterly update notices are published in each addition of the Network News which serves as the primary method HealthChoice uses to distribute other notifications mandated by the terms of the provider contracts.
A facility does not have to provide all of the services under the related bundle. However, if the facility signs an amendment for a particular bundle, it is agreeing that the facility will provide all services under that bundle according to the terms of the HealthChoice Select amendment, if the facility performs those services. Any services under that bundle the facility provides will be reimbursed under the HealthChoice Select Fee Schedule.
Providers must inform EGID if they want to make changes to the bundles the facility is contracted to provide. This includes changes that occur based on a change in the listed CPT/HCPC codes and/or pricing. An additional attachment “A” must be executed to add other bundles. A 30-day termination notice is required if the facility chooses to discontinue its participation in a bundle they currently provide.
If you have questions or need additional information, contact network management by calling 1-405-717-8790 or toll-free 1-844-804-2642 or by emailing EGID.NetworkManagement@omes.ok.gov.