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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.

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

07.12.2016

General Information For Providers, July 2016

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

Fee Schedules – APC

PDF Excel
01/26/2017 January 2017 APC 01/26/2017 January 2017 APC
10/25/2016 October 2016 APC 10/25/2016 October 2016 APC
07.21.2016 July 2016 APC 07.21.2016 July 2016 APC
07.21.2016 April 2016 APC 07.21.2016 April 2016 APC
02.05.2016 January 2016 APC Rev. 04.26.2016 02.05.2016 January 2016 APC Rev. 04.26.2016
10.20.2015 October 2015 APC 10.20.2015 October 2015 APC
08.03.2015 July 2015 APC 08.03.2015 July 2015 APC
05.05.2015 April 2015 APC 05.05.2015 April 2015 APC
02.2015 January 2015 APC 02.2015 January 2015 APC
10.2014 October 2014 APC 10.2014 October 2014 APC
07.2014 July 2014 APC 07.2014 July 2014 APC
05.12.2014 April 2014 APC 05.12.2014 April 2014 APC
01.31.2014 January 2014 APC 01.31.2014 January 2014 APC
10.2013 October 2013 APC 10.2013 October 2013 APC
08.2013 July 2013 APC 08.2013 July 2013 APC
04.2013 April 2013 APC 04.2013 April 2013 APC
02.2013 January 2013 APC 02.2013 January 2013 APC
11.2012 October 2012 APC 11.2012 October 2012 APC
08.2012 July 2012 APC 08.2012 July 2012 APC
04.2012 April 2012 APC 04.2012 April 2012 APC
01.2012 January 2012 APC 01.2012 January 2012 APC
11.2011 October 2011 APC 11.2011 October 2011 APC
09.2011 July 2011 APC 09.2011 July 2011 APC
06.2011 April 2011 APC 06.2011 April 2011 APC
03.2011 January 2011 APC 03.2011 January 2011 APC
12.2010 October 2010 APC 12.2010 October 2010 APC
08.2010 July 2010 APC 08.2010 July 2010 APC
04.2010 April 2010 APC 04.2010 April 2010 APC
01.2010 January 2010 APC 01.2010 January 2010 APC
10.2009 October 2009 APC 10.2009 October 2009 APC
08.2009 July 2009 APC 08.2009 July 2009 APC
06.2009 April 2009 APC 06.2009 April 2009 APC
04.2009 January 2009 APC 04.2009 January 2009 APC
11.2008 October 2008 APC 11.2008 October 2008 APC
08.2008 July 2008 APC 08.2008 July 2008 APC
05.2008 April 2008 APC 05.2008 April 2008 APC
>03.2008 January 2008 APC 03.2008 January 2008 APC
11.2007 October 2007 APC 11.2007 October 2007 APC
07.2007 July 2007 APC 07.2007 July 2007 APC
06.2007 April 2007 APC 06.2007 April 2007 APC
01.2007 January 2007 APC 01.2007 January 2007 APC
10.2006 October 2006 APC 10.2006 October 2006 APC
01.2006 January 2006 APC 01.2006 January 2006 APC
07.2006 July 2006 APC 07.2006 July 2006 APC
06.2006 April 2006 APC 06.2006 April 2006 APC
05.2006 January 2006 APC 05.2006 January 2006 APC
11.2005 October 2005 APC 11.2005 October 2005 APC
08.2005 July 2005 Fees 08.2005 July 2005 Fees
08.2005 July 2005 APC 08.2005 July 2005 APC
04.2005 April 2005 Fees 04.2005 April 2005 Fees
04.2005 April 2005 APC 04.2005 April 2005 APC
01.2005 January 2005 APC 01.2005 January 2005 APC
10.2004 October 2004 APC 10.2004 October 2004 APC
07.2004 July 2004 APC 07.2004 July 2004 APC
04.2004 April 2004 APC 04.2004 April 2004 APC
01.2004 January 2004 APC 01.2004 January 2004 APC
08.2003 August 2003 APC 08.2003 August 2003 APC

Fee Schedules – ATP Tests and Fees

PDF EXCEL
01/17/2017 January 2017 ATP 01/17/2017 January 2017 ATP
12.24.2015 January 2016 ATP  
01.2015 January 2015 ATP  
01.2014 January 2014 ATP  
02.2013 January 2013 ATP  
01.2012 January 2012 ATP  
01.2011 January 2011 ATP  
02.2010 January 2010 ATP  
02.2009 January 2009 ATP  
01.2007 January 2007 ATP  
01.2006 January 2006 ATP 04.2006  
03.2004 January 2004 ATP 01.2005  

Fee Schedules – Clinical Laboratory (CLAB)

Fee Schedules – Outpatient Procedure (OPP) Codes

PDF Excel
01/26/2017 January 2017 OPP Codes 01/26/2017 January 2017 OPP Codes
10/25/2016 October 2016 OPP Codes 10/25/2016 October 2016 OPP Codes
07.21.2016 July OPP Codes Rev. 07.26.2016 07.21.2016 July OPP Codes Rev. 07.26.2016
05.12.2016 April OPP Codes Rev. 07.11.2016 05.12.2016 April 2016 OPP Codes  Rev. 07.11.2016
02.05.2016 January 2016 OPP Codes Rev. 05.12.2016 02.05.2016 January 2016 OPP Codes Rev. 05.12.2016
10.20.2015 October 2015 OPP Codes Rev. 11.2015 10.20.2015 October 2015 OPP Codes Rev. 11.2015
08.03.2015 July 2015 OPP Codes Rev. 02.11.2016 08.03.2015 July 2015 OPP Codes Rev. 02.11.2016
05.05.2015 April 2015 OPP Codes 05.05.2015 April 2015 OPP Codes
02.2015 January 2015 OPP Codes 02.2015 January 2015 OPP Codes
10.2014 October 2014 OPP Codes Rev. 10.2014 October 2014 OPP Codes Rev.
07.2014 July 2014 OPP Codes Rev. 07.2014 July 2014 OPP Codes Rev.
05.2014 April 2014 OPP Codes Rev. 05.2014 April 2014 OPP Codes Rev.
01.2014 January 2014 OPP Codes 01.2014 January 2014 OPP Codes
10.2013 October 2013 OPP Codes 10.2013 October 2013 OPP Codes
08.2013 July 2013 OPP Codes Rev. 12.2013 08.2013 July 2013 OPP Codes Rev. 12.2013
04.2013 April 2013 OPP Codes 04.2013 April 2013 OPP Codes
03.2013 January 2013 OPP Codes 03.11.2013 03.2013 January 2013 OPP Codes 03.11.2013
02.2013 October 2012 OPP Codes Rev. 02.06.2013 02.2013 October 2012 OPP Codes Rev. 02.06.2013
>08.2012 July 2012 OPP Codes 08.2012 July 2012 OPP Codes
07.2012 April 2012 OPP Codes 07.2012 April 2012 OPP Codes
01.2012 January 2012 OPP Codes 01.2012 January 2012 OPP Codes
11.2011 October 2011 OPP Codes 11.2011 October 2011 OPP Codes
09.2011 July 2011 OPP Codes 09.2011 July 2011 OPP Codes
06.2011 April 2011 OPP Codes 06.2011 April 2011 OPP Codes
03.2011 January 2011 OPP Codes 03.2011 January 2011 OPP Codes
12.2010 October 2010 OPP Codes 12.2010 October 2010 OPP Codes
12.2010 July 2010 OPP Codes 12.2010 July 2010 OPP Codes
06.2010 April 2010 OPP Codes 06.2010 April 2010 OPP Codes
03.2010 January 2010 OPP Codes 03.2010 January 2010 OPP Codes
10.2009 October 2009 OPP Codes 10.2009 October 2009 OPP Codes
07.2009 July 2009 OPP Codes 07.2009 July 2009 OPP Codes
09.2009 April 2009 OPP Codes Rev. 09.2009 09.2009 April 2009 OPP Codes Rev. 09.2009
04.2009 January 2009 OPP Codes 04.2009 January 2009 OPP Codes
11.2008 October 2008 OPP Codes 11.2008 October 2008 OPP Codes
08.2008 July 2008 OPP Codes 08.2008 July 2008 OPP Codes
05.2008 April 2008 OPP Codes 05.2008 April 2008 OPP Codes
03.2008 January 2008 OPP Codes 03.2008 January 2008 OPP Codes
11.2007 October 2007 OPP Codes 11.2007 October 2007 OPP Codes
07.2007 July 2007 OPP Codes 07.2007 July 2007 OPP Codes
06.2007 April 2007 OPP Codes 06.2007 April 2007 OPP Codes
01.2007 January 2007 OPP Codes 01.2007 January 2007 OPP Codes
10.2006 October 2006 OPP Codes 10.2006 October 2006 OPP Codes
07.2006 July 2006 OPP Codes 07.2006 July 2006 OPP Codes
07.2006 April 2006 OPP Codes Updated from 06.2006 07.2006 April 2006 OPP Codes Updated from 06.2006
05.2006 January 2006 OPP Codes 05.2006 January 2006 OPP Codes
11.2005 October 2005 OPP Codes 11.2005 October 2005 OPP Codes
02.2005 January 2005 OPP Codes 02.2005 January 2005 OPP Codes
10.2004 October 2004 OPP Codes 10.2004 October 2004 OPP Codes
07.2004 July 2004 OPP Codes 07.2004 July 2004 OPP Codes
04.2004 April 2004 OPP Codes 04.2004 April 2004 OPP Codes
01.2004 January 2004 OPP Codes 01.2004 January 2004 OPP Codes
08.2003 August 2003 OPP Codes 08.2003 August 2003 OPP Codes
07.2002 July 2002 OPP Codes 07.2002 July 2002 OPP Codes
07.2001 July 2001 OPP Codes 07.2001 July 2001 OPP Codes

Provider Notices 2010–

2017

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

2013

12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update
11.26.2013 ICD-10 Readiness
09.27.2013 Changes to Prior Authorization Requirements for Therapeutic Youth Group Homes – Additional Information
09.24.2013 Changes to Contract With Magellan Medicaid Administration (MMA)
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
09.03.2013 Changes to Contract With Magellan Medicaid Administration (MMA)
07.08.2013 Montana Medicaid DSM-5 Implementation
06.28.2013 PRTF Montana-CANS Implementation
06.20.2013 Montana Plan First – Additional Information
05.31.2013 Children's Mental Health Services Plan (CMHSP) Rules Repealed
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
05.13.2013 Montana Plan First – Revised List of Plan First Covered Services
03.11.2013 Molecular Pathology Procedure Codes
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade
02.12.2013 BRCA1 and BRCA2 Testing Update
05.06.2013 Passport to Health Disenrollment Requirements for Providers Disenrolling a Member
02.11.2013 Montana Plan First Additional Information Updated
01.28.2013 Participating Providers: Prevention of Diabetes and Cardiovascular Disease

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
12.24.2012 BRCA1 and BRCA2 Testing
12.17.2012 American Medical Association Adopts New Psychiatric Diagnostic and Psychological Codes
09.26.2012 Changes to the Children's Mental Health Bureau's Provider Manual and Clinical Guidelines for Utilization Management and Authorization Request Forms
08.22.2012 Deleted ICD-9-CM Codes
06.11.2012 Plan First Effective 06.01.2012
02.15.2012 Non-Coverage of Artificial Disc
02.13.2012 Emergency Room Services Update
01.06.2012 Smoking and Tobacco Use Cessation Counselor Services
01.06.2012 Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Start Date Must Match Admission Date

2011

11.07.2011 Provider Information on HIPAA 5010 837 Health Care Claim Transactions
11.04.2011 Meeting the Requirements of HIPAA 5010 When Reporting National Drug Codes on Electronic 837I and 837P Transactions 11.16.2011
09.09.2011 HIPAA 5010 OCR Qualifier Changes Effective January 1, 2012
09.07.2011 Payment Error Rate Measurement (PERM)
07.18.2011 Reimbursement Changes for Covered Ancillary Services Provided to Youth in a PRTF and Additional Ancillary Services Are Covered
07.18.2011 Prior Authorization Requirements Discontinued for Targeted Case Management (TCM) and Outpatient Therapy Concurrent With Comprehensive School Community Treatment (CSCT)
06.27.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012
06.24.2011 PRTF Waiver Site Denial Required
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011

2010

10.05.2010 Changes to NCCI Edits
09.15.2010 Unlinking Passport Providers No Longer Part of Group Practice
07.28.2010 Provider Record Update Procedures
07.15.2010 Vaccine Update Effective February 23, 2010
06.23.2010 Cost Sharing Exemption under ARRA
06.23.2010 Changes to the First Health Services Provider Manuals, Clinical Guidelines and Forms Used for Utilization Management of Children's Mental Health Medicaid Services
06.22.2010 Electronic Health Records Link
06.04.2010 Medicaid Consultation Services
05.28.2010 Clinical Laboratory Fee Schedule (CLFS) Instructions for Test Codes 80100, 80101, 80101 QW, G0430, G0430 QW, and G0431 QW
05.24.2010 Transplant Program Update Updated 05.24.2010
02.09.2010 United States 2010 Census
02.08.2010 Medicaid Health Improvement Program
01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers

Provider Notices 2001–2009

2009

10.01.2009 Healthy Montana Kids Plan
09.22.2009 NDC Billing Tools
09.02.2009 Billing Procedures Regarding National Drug Code (NDC) When Using a UB-04 09.21.2009
06.02.2009 Clarification of Required NDC Information for Coverage of 17 Alpha-Hydroxyprogesterone Caproate (17-AHP)
03.16.2009 Timely Filing for Medicare Crossovers
03.05.2009 Vagus Nerve Stimulation (VNS) 03.10.2009
02.26.2009 ATP Lab Fees 03.12.2009
02.25.2009 Vaccines for Children (VFC) Effective as of October 10, 2008
02.12.2009 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers

2008

10.20.2008 Changes in Transplant Coverage 10.27.2008
09.03.2008 Tamper-Resistant Rx Pad Update: Three Features Required October 1
08.12.2008 Federal Government May Request Medical Records 09.18.2008
07.22.2008 Billing Procedures Regarding Electronic Claims (837P and 837I)
05.29.2008 When to Submit an NDC (National Drug Code) If You Are Billing as a 340B Provider
05.22.2008 Frequently Asked Questions About NPI Reenrollment and Billing 06.17.2008
05.13.2008 Medicaid and Medicare Dual Eligible Take-Home and Self-Administered Drugs
03.17.2008 Resubmission of Denied Claims 03.19.2008
03.11.2008 Billing Procedures Regarding National Drug Code (NDC) 10.15.2008
03.10.2008 NPI Reenrollment and Billing
02.28.2008 Enhanced Claims Editing – Bloodhound ClaimsGuard®
02.20.2008 Changes to Prior Authorization for Circumcision 08.05.2008
02.19.2008 New HCPCS and CPT Codes
02.13.2008 Tamper-Resistant Prescription Pads
01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange
01.11.2008 Vaccines for Children (VFC)

2007

12.28.2007 New Codes for Smoking and Tobacco Use Cessation Counseling
12.26.2007 WINASAP Upgrade Required for NDC Data Collection
12.17.2007 Enhanced Claims Editing – Assistant, Team, Co-Surgeon
12.17.2007 Enhanced Claims Editing – Multiple Evaluation and Management Services Provided on the Same Day
12.03.2007 NPI Requirement for Fee-for-Service Healthcare Provider Claims
11.30.2007 NDC Requirement on All Physician-Administered Drugs 01.17.2008
11.27.2007 Cost Share Changes
11.01.2007 Enhanced Claims Editing – Add-On Codes
11.01.2007 Enhanced Claims Editing – New Visit Evaluation and Management Codes
11.01.2007 Enhanced Claims Editing Bloodhound ClaimsGuard®
10.03.2007 VFC Update
10.01.2007 Attending Provider
10.01.2007 Tamper-Resistant Prescription Pads – Postponed
09.28.2007 Smoking and Tobacco Use Cessation Counseling
09.20.2007 Tamper-Resistant Prescription Pads – Updated
08.07.2007 Tamper-Resistant Prescription Pad Requirement
08.01.2007 Elimination of eSOR
07.06.2007 Coverage of 17 Alpha-Hydroxyprogesterone Caproate
06.25.2007 NPI on the Web Portal
06.11.2007 Ownership and Control Information Required for Reenrollment
06.06.2007 NPI Contingency Plan Implemented, Reenrollment Extended
05.31.2007 New CMS-1500 to Be Required Beginning July 2, 2007
04.16.2007 VFC Update Updated from 01.24.2007
04.16.2007 Coverage of HPV Vaccine
03.08.2007 New and Deleted Codes
03.08.2007 Cardiac and Pulmonary Rehabilitation No Longer Require a Prior Authorization for Outpatient Settings
01.22.2007 ATP Lab Fees
01.18.2007 Admit Hour to be Required for Institutional Claims

2006

11.02.2006 Processing of Outpatient Prospective Payment System (OPPS) Claims With Certain Drug Administration Code Pairs
11.02.2006 COBA Update
10.23.2006 Mileage Rate Increase Ambulance
09.22.2006 VFC Update
07.27.2006 Billing for Clients with Medicare and Medicaid – Revised
06.23.2006 Notice of Coverage for New Services Updated from 06.02.2006
05.09.2006 Changes in Observation Billing Updated from 01.2006
04.18.2006  VFC Update
04.11.2006 ATP Lab Fees
03.01.2006 VFC Update
02.10.2006 New and Deleted Codes
01.16.2006 January 2006 Outpatient Prospective Payment System (OPPS) Code Editor (OCE) Changes

2005

12.28.2005 Montana Medicaid Provider Website Now Offers Online Medical History
10.11.2005 Unbundling
07.28.2005 Scales – Congestive Heart Failure
07.01.2005 Revised Processing for Emergency Room Visits
07.01.2005 VFC Update
06.01.2005 Medicaid Coverage Update
04.11.2005 Dental Program Coverage Changes
03.01.2005 Hysterectomy Acknowledgement Update
02.04.2005 Introduction to Preferred Drug List
02.01.2005 Obstetric Observation Billing
02.01.2005 New and Deleted Codes and New Botox Criteria

2004

12.01.2004 Billing for Clients with Medicare and Medicaid
10.01.2004 Emergency Department Claims Appeal Process
07.01.2004 Dental and Denturist Code Changes and Manual Update
06.10.2004 Team Care Program A New Component of the Passport to Health Program
06.01.2004 Important Reminder Regarding Sterilizations, Hysterectomies and Abortions
04.27.2004 Observation Bed Criteria – Updated
04.27.2004 Sterilization/Hysterectomy and PA Update
03.16.2004 ATP Lab Fees
02.20.2004 Mass Adjustment
02.01.2004 New and Deleted Codes
01.22.2004 Lab and Radiology Services Covered Under MHSP Plan
01.01.2004 VFC Changes Updated from 12.2003
01.01.2004 New and Discontinued Optometric Codes

2003

12.08.2003 ED Claim Review Procedure
12.01.2003 Expanded Botox Criteria
12.01.2003 VFC Changes
12.01.2003 Discontinued Local Codes
11.10.2003 EMTALA Policy Change
10.30.2003 Continued Stay Review for Inpatient Rehabilitation
10.17.2003 Q & A Regarding Reporting ICD-9-CM Procedure Codes
10.14.2003 Form Locator Update
09.10.2003 Discontinued Services and Services That Now Require Prior Authorization Updated 09.2003
08.29.2003 Passport to Health Implementation in Prairie County
08.29.2003 DMEPOS Advisory Workgroup Openings
08.20.2003 Submitting HIPAA Compliant Claims – Information for All Providers
08.05.2003 ATP Lab Panel Fees
08.05.2003 Lab Panel Crosswalk
08.05.2003 Observation Bed Criteria
07.31.2003 Passport and Emergency Services
07.28.2003 Hysterectomy Requirements
05.22.2003 Air Transport Changes
05.12.2003 Provider Rate and Payment Update
05.01.2003 Outpatient Hospital Lab Panel Update
04.30.2003 Gastric Bypass Surgeries and Circumcisions
04.01.2003 Rehabilitation Update
02.03.2003 New Billing Requirements for UB-92 Billers
01.15.2003 Dental Program Changes
01.10.2003 New Provider Notification Procedure and Medicaid Changes

2001–2002

10.01.2002 Billing for Medicare Crossovers after Medicare's 45-Day Response Time
09.01.2002 Cost Sharing
07.01.2002 2.6% Reduction
06.20.2002 Passport to Health 24-Hour Availability
02.14.2002 Weekly Payment Available
10.17.2001 Dental Implants
08.15.2001 HCPCS Coding Clarification
05.29.2001 Billing for Lab Panels
05.09.2001 Billing for Abortion 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 10.2015

The TPL Carrier Code List has been removed from this website, for questions or concerns related to the document please contact mttpl@xerox.com. Thank you.