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Table of contents -- Minnesota Rules, chapter 5221, Fees for medical services



5221.0100 through 5221.0400 -- Definitions, Authority, Purpose and Scope


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5221.0100 Definitions

  • Subpart 1. Scope

  • Subp. 2. Bill or billing

  • Subp. 3. Charge

  • Subp. 4. Code

  • Subp. 5. Commissioner

  • Subp. 6. Compensable injury

  • Subp. 9. Injury

  • Subp. 10. Medical fee schedule

  • Subp. 11. Payer

  • Subp. 12. Provider

  • Subp. 14a. Relative value unit or RVU

  • Subp. 15 Service or treatment

5221.0200 Authority

5221.0300 Purpose

5221.0400 Scope

 

5221.0405 -- Incorporations by reference


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5221.0410 -- Required reporting and filing of medical information


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5221.0410 Required reporting and filing of medical information

  • Subpart 1. Scope

  • Subp. 2. Health care provider report

  • Subp. 3. Maximum medical improvement

  • Subp. 4. Permanent partial disability

  • Subp. 5. Required reporting to division

  • Subp. 6. Report of work ability

  • Subp. 7. Payment and coding for required and supplementary reporting

  • Subp. 8. Proper filing of documents with division

 

5221.0420 -- Health care provider participation with return to work planning


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5221.0420 Health care provider participation with return to work planning

  • Subpart 1. Cooperation with return to work planning

  • Subp. 2. Communication with assigned qualified rehabilitation consultant

  • Subp. 3. Reimbursement for services

 

5221.0430 -- Change of health care provider


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5221.0430 Change of health care provider

  • Subpart 1. Primary health care provider

  • Subp. 2. Change of health care provider

  • Subp. 3. Unauthorized change; prohibited payments

  • Subp. 4. Change of primary provider not approved

 

5221.0500 -- Excessive charges; limitation of payer liability


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5221.0500 Excessive charges; limitation of payer liability

  • Subpart 1. Excessive health care provider charges

  • Subp. 2. Limitation of payer liability

  • Subp. 3. Collection of excessive charges

 

5221.0600 -- Payer responsibilities


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5221.0600 Payer responsibilities

  • Subpart 1. Compensability

  • Subp. 2. Determination of excessiveness

  • Subp. 3. Determination of charges

  • Subp. 4. Notification

  • Subp. 5. Penalties

  • Subp. 6. Collection of excessive payment

 

5221.0650 -- Data collection, retention and reporting requirements


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5221.0650 Data collection, retention and reporting requirements

  • Subpart 1. Scope

  • Subp. 2. Purpose

  • Subp. 3. Retention period

  • Subp. 4. Required data

  • Subp. 5. Reporting requirements

 

5221.0700 -- Provider responsibilities


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5221.0700 Provider responsibilities

  • Subpart 1. Usual charges

  • Subp. 2. Submission of information

  • Subp. 3. Billing code

  • Subp. 4. Cooperation with payer

 

5221.4005 -- Instructions for application of fee schedule


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5221.4005 Instructions for application of fee schedule

  • Subpart 1. Workers' compensation medical fee schedule; incorporation of Medicare National Physician Relative Value Files

  • Subp. 2. Effective date

  • Subp. 3. Applicability

 

5221.4010 -- Employer's liability for services under medical fee schedule


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5221.4020 -- Determining fee schedule payment limits


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5221.4020 Determining fee schedule payment limits

  • Subpart 1b. Conversion factors and maximum fee formulas

  • Subp. 1c. Sample calculations

  • Subp. 2a. Key to abbreviations and terms and payment instructions

  • Subp. 3. Supplies, separate billing allowed

  • Subp. 4. Codes 99455 and 99456

 

5221.4030-- Medical/surgical procedure codes


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5221.4030 -- Medical/surgical procedure codes

  • Subpart 1. Key to abbreviations and terms

  • Subp. 3. List of medical/surgical procedure codes

 

5221.4033 -- Outpatient limitation for medical/surgical facility fee


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5221.4033 Outpatient limitation for medical/surgical facility fee

  • Subpart 1. No facility fee

  • Subp. 2b. Procedure codes subject to limitation

 

5221.4035 -- Fee adjustments for medical/surgical services


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5221.4035 Fee adjustments for medical/surgical services

  • Subpart 1. Definition of a global surgical package

  • Subp. 2. Components of a global surgical package

  • Subp. 3. Services not included in global surgical package

  • Subp. 4. Physicians furnishing less than full global package

  • Subp. 5. Coding and payment for multiple surgeries and procedures

  • Subp. 6. Coding and payment for bilateral surgeries and procedures

  • Subp. 7. Coding and payment for assistant-at-surgery

  • Subp. 8. Coding and payment for cosurgeons

  • Subp. 9. Coding and payment for team surgery

  • Subp. 10. Unbundling surgical services

 

5221.4040-- Pathology and laboratory procedure codes


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5221.4040 Pathology and laboratory procedure codes

  • Subpart 1. Key to abbreviations and terms

  • Subp. 3. List of pathology and laboratory codes

 

5221.4050 -- Physical medicine and rehabilitation procedure codes


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5221.4050 Physical medicine and rehabilitation procedure codes

  • Subpart 1. Key to abbreviations and terms

  • Subp. 2d. List of physical medicine and rehabilitation codes

  • Subp. 3. Additional payment instructions

 

5221.4051 -- Fee adjustments for physical medicine and rehabilitation services


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5221.4060 -- Chiropractic procedure codes


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5221.4060 Chiropractic procedure codes

  • Subpart 1. Key to abbreviations and terms

  • Subp. 2d. List of chiropractic procedure codes

  • Subp. 3. Select chiropractic procedure code descriptions, instructions and examples

  • Subp. 4. Evaluation and management services coding and reporting

 

5221.4061 -- Fee adjustments for chiropractic services


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5221.4061 Fee adjustments for chiropractic services

  • Subpart 1. Multiple modalities

  • Subp. 2. Extraspinal code

 

5221.4070 -- Pharmacy


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5221.4070 Pharmacy

  • Subpart 1. Substitution of generically equivalent drugs

  • Subp. 2. Procedure code; usual and customary charges

  • Subp. 3. Maximum fee

  • Subp. 4. Maximum fee for electronic transactions

  • Subp. 5. Other contracts

 

5221.6010 -- Authority


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5221.6020 -- Purpose and application


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5221.6020 Purpose and application

  • Subpart 1. Purpose

  • Subp. 2. Application

 

5221.6030 -- Incorporation by reference


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5221.6040 -- Definitions


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5221.6040 Definitions

  • Subpart 1. Scope

  • Subp. 2. Active treatment

  • Subp. 3. Chronic pain syndrome

  • Subp. 4. Condition

  • Subp. 5. Emergency treatment

  • Subp. 6. Etiology

  • Subp. 7. Functional status

  • Subp. 8. Initial nonsurgical management or treatment

  • Subp. 9. Medical imaging procedures

  • Subp. 10. Medically necessary treatment

  • Subp. 11. Neurologic deficit

  • Subp. 12. Passive treatment

  • Subp. 13. Therapeutic injection

 

5221.6050 -- General treatment parameters; excessive treatment; prior notification


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5221.6050 General treatment parameters; excessive treatment; prior notification

  • Subpart 1. General

  • Subp. 2. Documentation

  • Subp. 3. Nonoperative treatment

  • Subp. 4. Chemical dependency

  • Subp. 5. Referrals between health care providers

  • Subp. 6. Communication between health care providers and consideration of prior care

  • Subp. 7. Determination of excessive treatment; notice of denial to health care providers and employee; expedited processing of medical requests

  • Subp. 8. Departures from parameters

  • Subp. 9. Prior notification; health care provider and insurer responsibilities

  • Subp. 10. Certified managed care plans

  • Subp. 11. Outcome studies

 

5221.6100 -- Parameters for medical imaging


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5221.6100 Parameters for medical imaging

  • Subpart 1. General principles

  • Subp. 2. Specific imaging procedures for low back pain

 

5221.6105 -- Medications


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5221.6105 Medications

  • Subpart 1. Scope

  • Subp. 2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Subp. 3. Opiod analgesics

  • Subp. 4. Muscle relaxants

 

5221.6200 -- Low back pain


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5221.6200 Low back pain

  • Subpart 1. Diagnostic procedures for treatment of low back injury

  • Subp. 2. General treatment parameters for low back pain

  • Subp. 3. Passive treatment modalities

  • Subp. 4. Active treatment modalities

  • Subp. 5. Therapeutic injections

  • Subp. 6. Surgery, including decompression procedures and arthrodesis

  • Subp. 7. Chronic management

  • Subp. 8. Durable medical equipment

  • Subp. 9. Evaluation of treatment by health care provider

  • Subp. 10. Scheduled and nonscheduled medication

  • Subp. 11. Specific treatment parameters for regional low back pain

  • Supb. 12. Specific treatment parameters for radicular pain, with or without regional low back pain, with no or static neurologic deficits

  • Subp. 13. Specific treatment parameters for cauda equina syndrome and for radicular pain, with or without regional low back pain, with progressive neurologic deficits

 

5221.6205 -- Neck pain


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5221.6205 Neck pain

  • Subpart 1. Diagnostic procedures for treatment of neck injury

  • Subp. 2. General treatment parameters for neck pain

  • Subp. 3. Passive treatment modalities

  • Subp. 4. Active treatment modalities

  • Subp. 5. Therapeutic injections

  • Subp. 6. Surgery, including decompression procedures and arthrodesis

  • Subp. 7. Chronic management

  • Subp. 8. Durable medical equipment

  • Subp. 9. Evaluation of treatment by health care provider

  • Subp. 10. Scheduled and nonscheduled medication

  • Subp. 11. Specific treatment parameters for regional neck pain

  • Subp. 12. Specific treatment parameters for radicular pain, with or without regional neck pain, with no or static neurologic deficits

  • Subp. 13. Specific treatment parameters for radicular pain, with or without regional neck pain, with progressive neurologic changes

  • Subp. 14. Specific treatment parameters for myelopathy

 

5221.6210 -- Thoracic back pain


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5221.6210 Thoracic back pain

  • Subpart 1. Diagnostic procedures for treatment of thoracic back injury

  • Subp. 2. General treatment parameters for thoracic back pain

  • Subp. 3. Passive treatment modalities

  • Subp. 4. Active treatment modalities

  • Subp. 5. Therapeutic injections

  • Subp. 6. Surgery, including decompression procedures

  • Subp. 7. Chronic management

  • Subp. 8. Durable medical equipment

  • Subp. 9. Evaluation of treatment by health care provider

  • Subp. 10. Scheduled and nonscheduled medication

  • Subp. 11. Specific treatment parameters for regional thoracic back pain

  • Subp. 12. Specific treatment parameters for radicular pain

  • Subp. 13. Specific treatment parameters for myelopathy

 

5221.6300 -- Upper extremity disorders


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5221.6300 Upper extremity disorders

  • Subpart 1. Diagnostic procedures for treatment of upper extremity disorders (UED)

  • Subp. 2. General treatment parameters for upper extremity disorders

  • Subp. 3. Passive treatment modalities

  • Subp. 4. Active treatment modalities

  • Subp. 5. Therapeutic injections

  • Subp. 6. Surgery

  • Subp. 7. Chronic management

  • Subp. 8. Durable medical equipment

  • Subp. 9. Evaluation of treatment by health care provider

  • Subp. 10. Scheduled and nonscheduled medication

  • Subp. 11. Specific treatment parameters for epicondylitis

  • Subp. 12. Specific treatment parameters for tendonitis of forearm, wrist and hand

  • Subp. 13. Specific treatment parameters for nerve entrapment syndromes

  • Subp. 14. Specific treatment parameters for muscle pain syndromes

  • Subp. 15. Specific treatment parameters for shoulder impingement syndrome

  • Subp. 16. Specific treatment parameters for traumatic sprains and strains of the upper extremith

 

5221.6305 -- Complex regional pain syndrome (CRPS); reflex sympathetic dystrophy; and causalgia of the upper and lower extremities


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5221.6305 Complex regional pain syndrome (CRPS); reflex sympathetic dystrophy; and causalgia of the upper and lower extremities

  • Subpart 1. Scope

  • Subp. 2. Initial nonsurgical management

  • Subp. 3. Surgery

  • Subp. 4. Chronic management

 

5221.6400 -- Inpatient hospitalization parameters


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5221.6400 Inpatient hospitalization parameters

  • Subpart 1. General principles

  • Subp. 2. Specific requirements for hospital admission of patients with low back pain

 

5221.6500 -- Parameters for surgical procedures


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5221.6500 Parameters for surgical procedures

  • Subpart 1. General

  • Subp. 2. Spinal injury

  • Subp. 3. Upper extremity surgery

  • Subp. 4. Lower extremity surgery

 

5221.6600 -- Chronic management


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5221.6600 Chronic management

  • Subpart 1. Scope

  • Subp. 2. Chronic management modalities

 

5221.8900 -- Disciplinary action; penalties


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5221.8900 Disciplinary action; penalties

  • Subpart 1. Discipline

  • Subp. 2. Complaints

  • Subp. 3. Review and investigation

  • Subp. 4. Cooperation with disciplinary proceedings

  • Subp. 5. In-person meeting

  • Subp. 6. Resolution by instruction or written agreement

  • Subp. 7. Inappropriate, unnecessary or excessive treatment

  • Subp. 8. Violations of statutes and rules other than those involving inappropriate, unnecessary or excessive treatment

  • Subp. 9. Penalties

 

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