Ortho-Neuro Surgeons participating in this pilot bill using the following codes and limits for services provided:

Code/Description	Fees	Limits
1071M - Quality indicator incentive payment	Effective July 1, 2008 Tier 3 - $103.37 Tier 2 - $77.53 Tier 1 - $51.69 Effective July 1, 2007 Tier 3 - $94.72 Tier 2 - $71.04 Tier 1 - $47.36	Billed and payable to Ortho-Neuro Pilot Surgeon when the activity prescription form is also paid to the same provider for the same date of service. Payable during global surgery period.
1069M - Completion of the Activity Prescription Form (APF)	Effective July 1, 2008 $49.18 Effective July 1, 2007 $47.42	Billed and payable to Ortho-Neuro Pilot Surgeon when the activity prescription form is completed during an office visit and signed by the surgeon. The following procedures will not pay on the same date of service as 1069M: 1037M - Physical capacities evaluation (PCE) or restrictions, employer request. 1048M - Doctor's estimate of physical capacities.

Bill promptly for pilot services

Billing promptly will ensure that we have received all the information we need to assign you to the appropriate payment tier.

Know the bill payment cutoff dates

Bills are processed every other Friday. See cutoff and payment dates.

Payments are mailed during the week of the payment date (beginning on Tuesday).

Resources

• 1-800-848-0811 - Provider Hotline, for all billing questions and to request L&I published forms and manuals.
• 1-800-831-5227 - To get claim or bill status information through an automated phone line.
• 360-902-6511 - Electronic Billing Unit, to get billing information on State Fund claims
• For more information about this pilot, e-mail ONSQualityPilot@LNI.wa.gov.