Medical Services Provider Manual (MSPM)
Any appropriately licensed medical provider who is authorized by the employer or insurance carrier may treat workers' compensation claimants. The Medical Services Provider Manual (MSPM) outlines billing and payment policy for physicians and other health care professionals and provides the current schedule of fees. The MSPM does not cover hospital charges, general dental, or services rendered outside of South Carolina.
At the Business Meeting on March 13, 2023, the Commission approved the Conversion Factor of $51.50 for professional services and approved the Anesthesia Conversion factor of $32.85. The changes also include adopting the 20323 CMS CPT/HCPS codes.
The effective date of the updated MSPM is April 1, 2023.
Click the following link for information on how to purchase the 2023 Medical Services Provider Manual. It is imperative that providers and carriers obtain the 2023 MSPM to assure compliance.
2020-2023 Medical Service Provider Manuals
2006 Hospital and Ambulatory Surgical Center Payment Manual
The Hospital and Ambulatory Surgery Center Payment Manual describes the billing and payment policy for inpatient hospital stays and outpatient services rendered at a hospital or ambulatory surgical center. Effective October 1, 2006, healthcare facilities will be paid 40% more than the federal Medicare program pays for inpatient and outpatient services. 2006 Hospital and Ambulatory Surgical Center Payment Manual (PDF) Hospital and Ambulatory Payment Manual is updated quarterly as Medicare updates policies and pricing. The links below offer additional information regarding the inpatient prospective payment system, outpatient prospective payment system, and ambulatory surgery centers.
**Medical Services Division Advisory Statement**
Effective January 1, 2013 - Billing and Payment of Professional Fee Revenue Codes 960 through 999 (PDF)
Mandatory Payment Reduction in Medicare Fee-for-Service (FFS) Program. (PDF) This reduction does NOT apply to workers' compensation claims. (Posted April 23, 2013)