Hospital Outpatient Hospital Outpatient Provider Manuals General Information for Providers 02/2017 Medicaid manual with general information for all provider types. Hospital Outpatient Services 01/2016 This manual has information specific to your provider type. Critical Access Hospitals 01/2016 This manual has information specific to critical access hospitals. Passport to Health 11/2015 Everything a provider needs to know to become a successful Passport provider Rebateable Manufacturers 04/2017 Provider Manuals – Replacement Pages General Information for Providers 02/06/2017 In summary, the Telemedicine Chapter was added as a new chapter. And the Medically Needy section of the Member Responsibilities Chapter page 6.5 was updated. 08.02.2016 Introduction contains updated links in the HELP section. Cost Share was updated in the Billings Procedure. A duplicate word was removed in the RA chapter. The Cover Page was changed to reflect the current date of the new General Manual revision. 07.12.2016 General Information For Providers, July 2016 Table of Contents was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Index was amended by changing the title of “Basic Medicaid Waiver” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)”. Page 1.3 changed the title “Basic Medicaid Waiver for Additional Services and Populations” to “Waiver for Additional Services and Populations (formerly Basic Medicaid Waiver)” 01.19.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 01.15.2016 General Information for Providers, January 2016: Introduction Regarding HELP Plan Information 12.31.2015 General Information for Providers, January 2016: HELP Plan-Related Updates and Others 11.17.2015 General Information for Providers, November 2015: Billing Procedures, Revenue Codes 25X and 27X 07.31.2015 General Information for Providers, August 2015: Entire Manual 11.19.2014 General Information for Providers, November 2014: Billing Procedures 10.08.2014 General Information for Providers, September 2014: Billing Procedures 07.22.2014 General Information for Providers, July 2014: Member Eligibility and Responsibilities 06.30.2014 General Information for Providers, June 2014: General Information for Providers If information is found on the website, it has been removed from the manual, and a link to the source is provided. 04.13.2012 General Information for Providers, April 2012: Medicaid Covered Services and Client Eligibility Hospital Outpatient Services 12.31.2015 Hospital Outpatient Services, January 2016: HELP Plan-Related Updates and Others 11.17.2015 Hospital Outpatient Services, November 2015: Billing Procedures, Revenue Codes 25X and 27X 06.22.2015 Hospital Outpatient Services, May 2015: Entire Manual 07.05.2013 Hospital Outpatient Services, July 2013: Definitions and Index 06.27.2012 Hospital Outpatient Services, June 2012: Covered Services, Billing Procedures, How Payment Is Calculated 01.12.2012 Hospital Outpatient Services, December 2011: Hospital Outpatient Services 04.29.2011 Hospital Outpatient Services, April 2011: How Payment Is Calculated 12.16.2005 Hospital Outpatient Services, October 2005: New Instructions on Completing Medicaid Hysterectomy Acknowledgement Form 09.22.2004 Hospital Outpatient Services, August 2004: Team Care Added, Clarification on Sterilizations, Hysterectomies, Abortions, and MPQHF Phone Number Change Critical Access and Exempt Hospitals 12.31.2015 Critical Access and Exempt Hospitals, January 2016, HELP Plan-Related Updates and Others 04.27.2015 Critical Access and Exempt Hospitals, April 2015: Multiple Chapters 04.01.2014 Critical Access and Exempt Hospitals, March 2014: Key Contacts, MPQH Telephone and Fax 01.17.2006 Critical Access and Exempt Hospitals, January 2006: New Instructions on Completing Medicaid Hysterectomy Acknowledgement Form 11.02.2005 Critical Access and Exempt Hospitals, November 2005: Bundled Services Passport to Health 11.09.2015 Passport to Health, November 2015: Passport Referrals Medicaid Rules and Regulations Code of Federal Regulations (Title 42) Montana Code Annotated (Title 53, Chapter 6) Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services Fee Schedules – APC 04/27/2017 April 2017 APC Cover Sheet April 2017 APC Fee Schedule PDF April 2017 APC Fee Schedule Excel 01/26/2017 PDF January 2017 APC Excel January 2017 APC 10/25/2016 PDF October 2016 APC Excel October 2016 APC 07/21/2016 PDF July 2016 APC Excel July 2016 APC 07/21/2016 PDF April 2016 APC Excel April 2016 APC 02/05/2016 PDF January 2016 APC Rev 04/26/2016 Excel January 2016 APC Rev 04/26/2016 10/20/2015 PDF October 2015 APC Excel October 2015 APC 08/03/2015 PDF July 2015 APC 08/03/2015 July 2015 APC 05/05/2015 PDF April 2015 APC Excel April 2015 APC 02/2015 PDF January 2015 APC Excel January 2015 APC 10/2014 PDF October 2014 APC Excel October 2014 APC 07/2014 PDF July 2014 APC Excel July 2014 APC 05/12/2014 PDF April 2014 APC Excel April 2014 APC 01/31/2014 PDF January 2014 APC Excel January 2014 APC Fee Schedules – ATP Tests and Fees 01/17/2017 PDF January 2017 ATP EXCEL January 2017 ATP 12/24/2015 January 2016 ATP 01/2015 January 2015 ATP 01/2014 January 2014 ATP Fee Schedules – Clinical Laboratory (CLAB) 10/20/2015 PDF October 2015 Clinical Laboratory (CLAB) Excel October 2015 Clinical Laboratory (CLAB) 08/03/2015 PDF July 2015 Clinical Laboratory (CLAB) Excel July 2015 Clinical Laboratory (CLAB) 05/05/2015 PDF April 2015 Clinical Laboratory (CLAB) Excel April 2015 Clinical Laboratory (CLAB) 02/2015 PDFJanuary 2015 Clinical Laboratory (CLAB) Excel January 2015 Clinical Laboratory (CLAB) 10/2014 PDFOctober 2014 Clinical Laboratory (CLAB) Excel October 2014 Clinical Laboratory (CLAB) 07/2014 PDFJuly 2014 Clinical Laboratory (CLAB) Excel July 2014 Clinical Laboratory (CLAB) 04/2014 PDFApril 2014 Clinical Laboratory (CLAB) Excel April 2014 Clinical Laboratory (CLAB) 01/2014 PDFJanuary 2014 Clinical Laboratory (CLAB) Excel January 2014 Clinical Laboratory (CLAB) Fee Schedules – Outpatient Procedure (OPP) Codes 04/27/2017 April 2017 OPP Cover Sheet April 2017 OPP Fee Schedule PDF April 2017 OPP Fee Schedule Excel 01/26/2017PDF January 2017 OPP Codes 01/26/2017 EXCEL January 2017 OPP Codes 10/25/2016 PDF October 2016 OPP Codes 10/25/2016 EXCEL October 2016 OPP Codes 07/21/2016 PDF July OPP Codes Rev 07/26/2016 EXCEL July OPP Codes Rev 07/26/2016 05/12/2016 PDF April OPP Codes Rev 07/11/2016 EXCEL April 2016 OPP Codes Rev 07/11/2016 02/05/2016 PDF January 2016 OPP Codes Rev 05/12/2016 EXCEL January 2016 OPP Codes Rev 05/12/2016 10/20/2015 PDF October 2015 OPP Codes Rev 11/2015 EXCEL October 2015 OPP Codes Rev 11/2015 08/03/2015 PDF July 2015 OPP Codes Rev02/11/2016 EXCEL July 2015 OPP Codes Rev 02/11/2016 05/05/2015 PDF April 2015 OPP Codes 05/05/2015 EXCEL April 2015 OPP Codes 02/2015 PDF January 2015 OPP Codes EXCEL January 2015 OPP Codes 10/2014 PDF October 2014 OPP Codes Rev EXCEL October 2014 OPP Codes Rev 07/2014 PDF July 2014 OPP Codes Rev EXCEL July 2014 OPP Codes Rev 05/2014 PDF April 2014 OPP Codes Rev EXCEL April 2014 OPP Codes Rev 01/2014 PDF January 2014 OPP Codes EXCEL January 2014 OPP Codes Provider Notices 2017 05/01/2017 Vaccine Administration Code Update 04/24/2017 Unlisted Services or Procedures Reminder 04/20/2017 Plan First Hysterectomy codes added effective April 1, 2017 04/06/2017 New EPSDT Request Form 03/16/2017 Physician Administered Drugs - Update 02/02/2017 EPSDT ( Children's) Lead Screening Requirements 02/02/2017 Change to Medicaid Outpatient Lab Billing 2016 12/08/2016 Physician Administered Drugs - Local Anesthetics 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016 09/27/2016 Physician Administered Drugs - NDC Requirements Revised 07/28/2016 Montana Plan First Preventive Code Additions 07/25/2016 Admission Date and Statement Covers Period - Revised 07/18/2016 Changes to Member Cost Share Update 07/12/2016 Vaccine Administration Code Update 07/05/2016 PA For Botox No Longer Required 07/05/2016 Circumcision Prior Authorization Changes 07/01/2016 Admission Date and Statement Covers Period 05/19/2016 Changes to Member Cost Share 04/07/2016 Montana Plan First - IUD and Anesthesia Updates 04/05/2016 Place of Service Code Change 03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims 03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016 02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials 02/10/2016 ICD-10 Obstetric Observation Billing Update 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit 01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital 01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016 01/15/2016 Hospital Grade Electric Breast Pump Requirements 2015 12/31/2015 Changes to Montana Medicaid 12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization 12/09/2015 Increasing Coverage of Lactation Services to Outpatient Hospitals 11/23/2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev/ 12/2015 11/18/2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev/ 12/21/2015 11/03/2015 Services Exempt from Passport to Health Referral 10/21/2015 ICD-10 Obstetric Observation Billing 10/21/2015 SmartPA® Prior Authorization for Synagis® 10/09/2015 Montana Plan First – ICD-10 Update 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual 08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions 08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10) 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana 07/21/2015 Discarded Drugs and Biologicals and the Use of the JW Modifier 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services 06/26/2015 Vaccine Administrative Code Update 06/09/2015 National Drug Code (NDC) Billing 03/11/2015 Criteria for Breast Reconstruction 03/11/2015 Criteria for Prophylactic Mastectomy 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU 01/30/2015 Telehealth Diagnosis Codes 01/07/2016 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital 2014 12/18/2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice 10/20/2014 SmartPA® Prior Authorization for Synagis® 09/16/2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana 09/01/2014 Cardiac and Pulmonary Rehabilitation Outpatient Updates 08/05/2014 Montana Prescription Drug Registry 06/25/2014 Elective Deliveries – Hospitals 06/25/2014 Medicaid Outpatient Lab Billing 06/12/2014 ICD-10 Delay 05/13/2014 PERM Provider Educational Webinars 04/02/2014 Medicaid and G Codes Update 03/18/2014 Information Regarding CMS-1500 03/18/2014 Billing Multiple Same-Day Visits on a UB-04 or 837I and Condition Code G0 02/28/2014 Medicaid Outpatient Laboratory Billing Rev 01/29/2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update 01/17/2014 Medicaid and G-Codes See Update 04/02/2014 01/09/2014 Using Medicaid Card ID Number When Billing and Checking Eligibility 01/09/2014 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Information Pertaining to PRTF Services Other Resources APR - DRG FAQ EOB R&R Crosswalk in PDF Format and EOB R&R Crosswalk in Excel Format 02/2011 With the implementation of HIPAA, Medicaid will discontinue the use of Medicaid EOB codes and begin using HIPAA standard reason and remark (R&R) codes. This document crosswalks the HIPAA standard R&R codes to the Medicaid EOB codes. Lab Panels 2007 01/2007 List of codes that make up lab panels for 2004–2007. Lab Panel Crosswalk 08/05/2003 CPT codes which make up organ or disease oriented panels and evocative. suppression testing. Outpatient Hospital Payment Summary 08/01/2003 Technical specifications for the new hospital outpatient payment method. Outpatient Prospective Payment System Billing Guide 08/28/2006 PowerPoint Presentation: Outpatient Prospective Billing Guide. If you do not have Microsoft PowerPoint, download PowerPoint Viewer Prior Authorization Criteria for Specific Services Rebateable Manufacturers 01/2017 SURS Provider Self-Audit Protocol 1/2015 To locate older documents, access the Archive Page.