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)

 

PDF Excel
07.2016 July 2016 Nutrition Rev 02/02/2016 07.2016 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  
07.2011 August 2011 Nutrition  
07.2009 July 2009 Nutrition  
07.2008 July 2008 Nutrition  
07.2006 July 2006 Nutrition  
01.2006 January 2006 Nutrition  
07.2004 July 2004 Nutrition  
01.2004 January 2004 Nutrition  
07.2003 July 2003 Nutrition  
01.2003 January 2003 Nutrition  
07.2002 July 2002 Nutrition  

 

Fee Schedules – O&M Specialist

Fee Schedules – Private Duty Nursing

Fee Schedules – Respiratory

Provider Notices 2010–

2017

04/21/2017 Bowl Management Program Supplies
04/06/2017 New EPSDT Request Form
03/31/2017  Ketone Test Strips - A4250 & A252
02/07/2017 New Place of Service for Telehealth
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

2016

09/26/2016 Coverage of Weighted Blankets
07.18.2016 Changes to Member Cost Share Update
05.19.2016 Changes to Member Cost Share
02.01.2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
01.15.2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01.19.2016

2015

12.31.2015 Changes to Montana Medicaid
11.13.2015 Oral Nutrition for Children Under Age 21 – EPSDT
11.03.2015 Services Exempt from Passport to Health Referral
10.01.2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
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
02.11.2015 New HCPCS Modifiers – XE, XP, XS, and XU

2014

12.18.2014 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Final Notice
09.16.2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana
08.05.2014 Montana Prescription Drug Registry
06.27.2014 Orientation and Mobility Specialists: Reimbursement Rate Changes and New Method of Payment
06.12.2014 ICD-10 Delay
05.13.2014 PERM Provider Educational Webinars
03.18.2014 Information Regarding CMS-1500
01.29.2014 Centers for Medicare and Medicaid Services (CMS) ICD-10 Provider Readiness Assessment Update
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
11.07.2013 Medicaid Passport to Health Referrals and Fee Schedules
09.11.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes
09.10.2013 New Services for Orientation and Mobility (O&M) Specialists for Schools
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade

 2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
08.22.2012 Deleted ICD-9-CM Codes
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
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
06.27.2011 HIPAA 5010 / OCR Qualifier Changes Effective January 1, 2012
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011

2010

10.05.2010 Changes to NCCI Edits
07.28.2010 Provider Record Update Procedures
06.23.2010 Cost Sharing Exemption under ARRA
06.23.2010 Resource-Based Relative Value Scale (RBRVS) Information
06.22.2010 Electronic Health Records Link
02.09.2010 United States 2010 Census
01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers

Provider Notices 2000–2009

2009

10.01.2009 Healthy Montana Kids Plan
03.16.2009 Timely Filing for Medicare Crossovers
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 Rev. 10.27.2008
08.12.2008 Federal Government May Request Medical Records Rev. 09.18.2008
07.10.2008 Multiple Conversion Factors for RBRVS Providers
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 Rev. 06.17.2008
03.17.2008 Resubmission of Denied Claims Rev. 03.19.2008
03.10.2008 NPI Reenrollment and Billing
01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange

2007

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
11.27.2007 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®
08.01.2007 Elimination of eSOR
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

2000–2006

07.25.2006 Replacement Pages Physician-Related Services Well-Child EPSDT Update
07.14.2006 EPSDT Private Duty Nursing Service Changes
01.05.2006 Increased Reimbursement for EPSDT Preventive Services
07.28.2005 Scales – Congestive Heart Failure
02.04.2005 Introduction to Preferred Drug List
06.10.2004 Team Care Program A New Component of the Passport to Health Program
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
01.10.2003 New Provider Notification Procedure and Medicaid Changes
10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time
07.01.2002 2.6% Reduction
06.20.2002 Passport to Health 24-Hour Availability
02.14.2002 Weekly Payment Available
06.01.2001 Global Surgery Periods Effective 07.01.2001
03.20.2000 Global Surgery Periods Effective 05.01.2000

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
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.