2006 Minnesota Statutes

256B.0626 ESTIMATION OF 50TH PERCENTILE OF PREVAILING CHARGES.
(a) The 50th percentile of the prevailing charge for the base year identified in statute must
be estimated by the commissioner in the following situations:
(1) there were less than five billings in the calendar year specified in legislation governing
maximum payment rates;
(2) the service was not available in the calendar year specified in legislation governing
maximum payment rates;
(3) the payment amount is the result of a provider appeal;
(4) the procedure code description has changed since the calendar year specified in legislation
governing maximum payment rates, and, therefore, the prevailing charge information reflects the
same code but a different procedure description; or
(5) the 50th percentile reflects a payment which is grossly inequitable when compared with
payment rates for procedures or services which are substantially similar.
(b) When one of the situations identified in paragraph (a) occurs, the commissioner shall
use the following methodology to reconstruct a rate comparable to the 50th percentile of the
prevailing rate:
(1) refer to information which exists for the first four billings in the calendar year specified in
legislation governing maximum payment rates; or
(2) refer to surrounding or comparable procedure codes; or
(3) refer to the 50th percentile of years subsequent to the calendar year specified in legislation
governing maximum payment rates, and reduce that amount by applying an appropriate Consumer
Price Index formula; or
(4) refer to relative value indexes; or
(5) refer to reimbursement information from other third parties, such as Medicare.
History: 1Sp1993 c 1 art 5 s 50; 1997 c 203 art 4 s 27