Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » EPSDT

Main Content

EPSDT

EPSDT / Children’s Services

Early and Periodic Screening, Diagnostic, and Treatment Services

Please note: If you require Children's Chiropractic (EPSDT) information visit the Children's Chiropractic (EPSDT) provider type.

Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

This manual has information specific to your provider type.

Nutrition EPSDT 01/2016

This manual has information specific to your provider type.

Orientation and Mobility Specialist 08/2013

This manual has information specific to your provider type.

Physician-Related Services 11/2016

This manual has information specific to your provider type.

Private Duty Nursing EPSDT 01/2016

This manual has information specific to your provider type.

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.
09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor
language changes and the Cover reflects the current date.

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, June 2014: Member Eligibility and Responsibilities, Presumptive Eligibility
06.30.2014 General Information for Providers, June 2014: Entire Manual
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
04.29.2005 General Information for Providers, April 2005: Member Number a Billable Number and Key Contacts Updated
11.05.2004 General Information for Providers, November 2004: References to Medicaid Rules and Regulations Added
09.16.2004 General Information for Providers, September 2004: Team Care and Nurse First Information Added

Nutrition (EPSDT)

12.31.2015 Nutrition Services, January 2016: HELP Plan-Related Updates and Others

Private Duty Nursing (EPSDT)

12.31.2015 Private Duty Nursing Services, January 2016: HELP Plan-Related Updates and Others

Physician-Related Services

11/28/2016 In summary, the Page 5.6 of the Billing Procedures chapter was amended to add information for locum tenens, several links were updated, and two blank pages were removed. The Table of Contents and Index sections were adjusted, several links were updated in the Introduction and Covered Services Chapter, the entire manual was formatted as approved by the September 2016 Manuals Meeting for initial 508 adaptations, and the Cover page was amended with the current date.
09/12/2016 In summary, the entire manual has undergone formatting changes, the Billing Procedures section has had some minor language changes and the Cover reflects the current date.
08.31.2016 In summary, The cost share section was removed from the Billing Procedures Chapter, related entries were removed from the Index Section adjustments were made to the Index Section , and the date was changed on the Cover Page.
07.31.2015 Physician-Related Services, August 2015: Entire Manual, Removed EPSDT Well-Child
07.08.2014 Physician-Related Services, July 2014: Multiple Chapters
07.14.2008 Physician-Related Services, March 2008: Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations
07.25.2006 Physician-Related Services, July 2006: Well-Child EPSDT Update
04.25.2006 Physician-Related Services, April 2006: Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment
01.05.2006 Physician-Related Services, September 2005: New EPSDT, Hysterectomy Acknowledgement Form, Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients Under Age 2
03.01.2005 Physician-Related Services, March 2005: Hysterectomy Acknowledgement Update
01.25.2005 Physician-Related Services, January 2005: Rule References Added, Updates to Covered Services, PA and Modifiers
11.16.2004 Physician-Related Services, November 2004: Updated Prescription Drug PA Criteria
09.15.2004 Physician-Related Services, September 2004: Team Care Added
06.16.2004 Physician-Related Services, July 2004: Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update
12.23.2003 Physician-Related Services, December 2003: Immunizations, PA Criteria, Family Planning, and Using Modifiers
09.16.2003 Physician-Related Services, September 2003: Hysterectomies and Prescription Drug PA Update
08.20.2003 Physician-Related Services, June 2003: New Emergency Services Policy and Hard Card Information
07.28.2003 Physician-Related Services, Hysterectomy Requirements
06.01.2003 Physician-Related Services, New PA Requirements and Hysterectomy Information
01.02.2003 Physician-Related Services, January 2003: Prior Authorization
09.01.2002 Physician-Related Services, September 2002: Cost Sharing

Medicaid Rules and Regulations

Fee Schedules – Children's Special Health Services

Fee Schedules - Nutritionist (EPSDT)

07/2016 PDF July 2016 Nutrition Rev 02/02/2016 Excel July 2016 Nutrition Rev 02/02/2016  
07/2015 July 2015 Nutrition  
07/2014 July 2014 Nutrition  
12/2013 December 2013 Nutrition  
07/2013 July 2013 Nutrition 

 

Fee Schedules – O&M Specialist

Fee Schedules – Private Duty Nursing

Fee Schedules – Respiratory

Provider Notices

Other Resources

EOB R&R Crosswalk PDF and EOB R&R Crosswalk Excel 02/2011
With the implementation of HIPAA, Medicaid discontinued the use of Medicaid EOB codes and began using HIPAA standard reason and remark (R&R) codes. This document crosswalks the HIPAA standard R&R codes to the Medicaid EOB codes.


SURS Provider Self-Audit Protocol 10/2015
 

 

 

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