Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Outpatient

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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 07/2017



Medicaid Rules and Regulations

Fee Schedules – APC

07/27/2017 July 2017 APC Cover Sheet   July 2017 APC Fee Schedule PDF  July 2017 APC Fee Schedule Excel
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)

Fee Schedules – Outpatient Procedure (OPP) Codes

07/27/2017 July 2017 OPP Cover Sheet    July 2017 OPP Fee Schedule PDF Rev. 08/01/2017  July 2017 OPP Fee Schedule Excel  Rev. 08/01/2017
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


08/01/2017 Telemedicine - Correction
07/25/2017 Physician Administered Drugs - Update - NDC Requirements
07/25/2017 Physician Administered Code Update - Procedure Codes Rev. 07/26/2017
07/03/2017 Clinical Pharmacist Practitioner
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


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


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


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


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 07/2017

SURS Provider Self-Audit Protocol 1/2015


To locate older documents, access the Archive Page.