Medical Fee Schedule

IDAPA Rules 17.01.01.803 Medical Fees

Please contact the Medical Fee Coordinator for further information at (208) 334-6000.

PAYMENT CALCULATION RESOURCES

Physicians: RBRVS

Hospital Inpatient MS-DRG

Hospital Outpatient & Ambulatory Surgery Centers (ASC)

Effective January 1, 2021

Effective January 1, 2020

Effective January 1, 2019

Effective January 1, 2018

Idaho Critical Access Hospitals 

List of Idaho Hospitals

The Commission has prepared some items to help navigate the medical fee dispute process.  Below are tips for filing a motion for approval of a disputed charge.  The Commission has also created a separate page to answer frequently asked questions.

Tips for Success in Medical Fee Disputes:

  1. DO list in the motion:
    1. The date the bill was sent/received.
    2. The date the Preliminary Objection was sent/received.
    3. The date the Response was sent/received.
    4. The date the Final Objection was sent/received.
  2. DO check the deadlines before you send the motion.
  3. DO use the standard forms.
  4. DO itemize billings by CPT code.
  5. DO provide copies of the
    1. Bills (but indicate which part of the bill is in dispute)
    2. Preliminary Objection
    3. Response
    4. Final Objection
  6. DO understand that Commission staff are legal, not medical, professionals, and that the dispute process is a legal, not medical, forum.
  7. DO send copies to the other parties.
    1. If service was completed by facsimile, please include the fax number and a copy of the confirmation page.
  8. DO indicate the dates of the documents.
  9. DON’T send in multiple copies of the same item.
  10. DON’T send a bunch of medical records or billing items and expect the Commission staff to sort them out.
  11. DON’T forget to fully complete a certificate of service/mailing.
  12. DON’T hesitate to call Commission staff before you send in the motion if you have any questions.

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