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  09/2017
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

2017

09/25/2017 Vaccine Administration Code Update
09/19/2017 Individual Adjustment Request Form on Split Claims
09/14/2017 Montana Plan First Anesthesia Update
08/21/2017 Clinical Pharmacist Practitioner
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

2016

PDF: 12/08/2016 Physician Administered Drugs - Local Anesthetics
TXT:  12/08/2016 Physician Administered Drugs - Local Anesthetics
PDF: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
TXT:  11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
PDF: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
TXT:  09/27/2016 Physician Administered Drugs - NDC Requirements Revised
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT:  07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/25/2016 Admission Date and Statement Covers Period - Revised
TXT:  07/25/2016 Admission Date and Statement Covers Period - Revised
PDF: 07/18/2016 Changes to Member Cost Share Update
TXT:  07/18/2016 Changes to Member Cost Share Update
PDF: 07/12/2016 Vaccine Administration Code Update
TXT:  07/12/2016 Vaccine Administration Code Update
PDF: 07/05/2016 PA For Botox No Longer Required
TXT:  07/05/2016 PA For Botox No Longer Required
PDF: 07/05/2016 Circumcision Prior Authorization Changes
TXT:  07/05/2016 Circumcision Prior Authorization Changes
PDF: 07/01/2016 Admission Date and Statement Covers Period
TXT:  07/01/2016 Admission Date and Statement Covers Period
PDF: 05/19/2016 Changes to Member Cost Share
TXT:  05/19/2016 Changes to Member Cost Share
PDF: 04/07/2016 Montana Plan First - IUD and Anesthesia Updates
TXT:  04/07/2016 Montana Plan First - IUD and Anesthesia Updates
PDF: 04/05/2016 Place of Service Code Change
TXT:  04/05/2016 Place of Service Code Change
PDF: 03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims
TXT:  03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims
PDF: 03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016
TXT:  03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016
PDF: 02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials
TXT:  02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials
PDF: 02/10/2016 ICD-10 Obstetric Observation Billing Update
TXT:  02/10/2016 ICD-10 Obstetric Observation Billing Update
PDF: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
TXT:  02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
PDF: 01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
TXT:  01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
PDF: 01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes
TXT:  01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes
PDF: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
TXT:  01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev/ 01/19/2016
PDF: 01/15/2016 Hospital Grade Electric Breast Pump Requirements
TXT:  01/15/2016 Hospital Grade Electric Breast Pump Requirements

2015

PDF: 12/31/2015 Changes to Montana Medicaid
TXT:  12/31/2015 Changes to Montana Medicaid
PDF: 12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
TXT:  12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
PDF: 12/09/2015 Increasing Coverage of Lactation Services to Outpatient Hospitals
TXT:  12/09/2015 Increasing Coverage of Lactation Services to Outpatient Hospitals
PDF: 11/23/2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev/ 12/2015
TXT:  11/23/2015 Prior Authorization Requests
PDF: 11/18/2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev/ 12/21/2015
TXT:  11/18/2015 Hospital National Drug Code (NDC) Billing on Revenue Codes Rev/ 12/21/2015
PDF: 11/03/2015 Services Exempt from Passport to Health Referral
TXT:  11/03/2015 Services Exempt from Passport to Health Referral
PDF: 10/21/2015 ICD-10 Obstetric Observation Billing
TXT:  10/21/2015 ICD-10 Obstetric Observation Billing
PDF: 10/21/2015 SmartPA® Prior Authorization for Synagis®
TXT:  10/21/2015 SmartPA® Prior Authorization for Synagis®
PDF: 10/09/2015 Montana Plan First – ICD-10 Update
TXT:  10/09/2015 Montana Plan First – ICD-10 Update
PDF: 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
TXT:  10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
PDF: 08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions
TXT:  08/19/2015 Identification of Ordering and Referring Providers on UB-04 and 837I X12 Transactions
PDF: 08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows
TXT:  08/17/2015 Medicare Crossover Claims With Medicare Non-Covered Charges That Medicaid Allows
PDF: 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
TXT:  08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
PDF: 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
TXT:  07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
PDF: 07/21/2015 Discarded Drugs and Biologicals and the Use of the JW Modifier
TXT:  07/21/2015 Discarded Drugs and Biologicals and the Use of the JW Modifier
PDF: 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
TXT:  07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
PDF: 06/26/2015 Vaccine Administrative Code Update
TXT:  06/26/2015 Vaccine Administrative Code Update
PDF: 06/09/2015 National Drug Code (NDC) Billing
TXT:  06/09/2015 National Drug Code (NDC) Billing
PDF: 03/11/2015 Criteria for Breast Reconstruction
TXT:  03/11/2015 Criteria for Breast Reconstruction
PDF: 03/11/2015 Criteria for Prophylactic Mastectomy
TXT:  03/11/2015 Criteria for Prophylactic Mastectomy
PDF: 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
TXT:  02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
PDF: 01/30/2015 Telehealth Diagnosis Codes
TXT:  01/30/2015 Telehealth Diagnosis Codes
PDF: 01/07/2016 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital
TXT:  01/07/2016 Long Acting Reversible Contraception (LARC) Inserted at Time of Delivery in a PPS Hospital

Other Resources

APR - DRG FAQ

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

 

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