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Montana Healthcare Programs Provider Information » Podiatrist

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Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Physician-Related Services 11/2016

This manual has information specific to your provider type.

Provider Manuals – Replacement Pages

General Information for Providers

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.



General Information for Providers, January 2016: Introduction Regarding HELP Plan Information
General Information for Providers, January 2016: Introduction Regarding HELP Plan Information
General Information for Providers, January 2016: HELP Plan-Related Updates and Others
General Information for Providers, November 2015: Billing Procedures, Revenue Codes 25X and 27X
General Information for Providers, August 2015: Entire Manual
General Information for Providers, November 2014: Billing Procedures
General Information for Providers, September 2014: Billing Procedures
General Information for Providers, June 2014: Member Eligibility and Responsibilities, Presumptive Eligibility
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
General Information for Providers: Medicaid Covered Services and Client Eligibility

Physician-Related Services

 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.
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.
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
Physician-Related Services, August 2015: Entire Manual
Physician-Related Services, July 2014: Multiple Chapters
Physician-Related Services, March 2008: Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations
Physician-Related Services, July 2006: Well-Child EPSDT Update
Physician-Related Services, April 2006: Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment
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
Physician-Related Services, March 2005: Hysterectomy Acknowledgement Update
Physician-Related Services, January 2005: Rule References Added, Updates to Covered Services, PA and Modifiers
Physician-Related Services, November 2004: Updated Prescription Drug PA Criteria
Physician-Related Services, September 2004: Team Care Added
Physician-Related Services, July 2004: Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update
Physician-Related Services, December 2003: Immunizations, PA Criteria, Family Planning, and Using Modifiers
Physician-Related Services, September 2003: Hysterectomies and Prescription Drug PA Update
Physician-Related Services, June 2003: New Emergency Services Policy and Hard Card Information
Physician-Related Services, August 2003: Hysterectomy Requirements
Physician-Related Services, June 2003: New PA Requirements and Hysterectomy Information
Physician-Related Services, January 2003: Prior Authorization
Physician-Related Services, September 2002: Cost Sharing


Medicaid Rules and Regulations

Fee Schedules – Podiatry

Podiatry Fee Schedules

PDF: January 2017 Podiatry
Excel:January 2017 Podiatry
PDF:July 2016 Podiatry Rev. 07.13.2016
Excel:July 2016 Podiatry Rev. 07.13.2016
PDF:January 2016 Podiatry
Excel:January 2016 Podiatry
PDF:July 2015 Podiatry
Excel:July 2015 Podiatry
PDF:January 2015 Podiatry
Excel:January 2015 Podiatry
PDF:July 2014 Podiatry
Excel:July 2014 Podiatry
PDF:January 2014 Podiatry
Excel:January 2014 Podiatry
PDF:December 2013 Podiatry
Excel:December 2013 Podiatry
PDF:July 2013 Podiatry Revised 12.2013
Excel:July 2013 Podiatry Revised 12.2013
PDF:January 2013 Podiatry
Excel:January 2013 Podiatry
PDF:July 2012 Podiatry
Excel:July 2012 Podiatry
PDF:January 2012 Podiatry
Excel:January 2012 Podiatry
PDF:September 2011 Podiatry Revised 11. 2011
Excel:September 2011 Podiatry Revised 11. 2011
PDF:January 2011 Podiatry
Excel:January 2011 Podiatry
PDF:July 2010 Podiatry
Excel:July 2010 Podiatry
PDF:January 2010 Podiatry
Excel:January 2010 Podiatry
PDF:July 2009 Podiatry
Excel:July 2009 Podiatry
PDF:January 2009 Podiatry
Excel:January 2009 Podiatry
PDF:July 2008 Podiatry
Excel:July 2008 Podiatry
PDF: January 2008 Podiatry
Excel:January 2008 Podiatry
PDF:October 2007 Podiatry
Excel:October 2007 Podiatry
PDF:January 2007 Podiatry
Excel:January 2007 Podiatry
PDF:July 2006 Podiatry
Excel:July 2006 Podiatry
PDF:January 2006 Podiatry
Excel:January 2006 Podiatry
PDF:July 2005 Podiatry
Excel:July 2005 Podiatry
PDF:January 2005 Podiatry
Excel:January 2005 Podiatry
PDF:July 2004 Podiatry
Excel:July 2004 Podiatry
PDF:January 2004 Podiatry
Excel:January 2004 Podiatry
PDF: July 2003 Podiatry
Excel:July 2003 Podiatry
PDF:January 2003 Podiatry
Excel:July 2003 Podiatry
PDF:July 2002 Podiatry
Excel:July 2002 Podiatry
PDF:January 2002 Podiatry
Excel:January 2002 Podiatry

Fee Schedules – ATP Tests and Fees


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 Revised 04.2006

03.2004 January 2004 ATP Revised 01.2005

Provider Notices 2010–


04/06/2017 New EPSDT Request Form
03/07/2017   Reminder: Billing for Services in ASCs


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 Benefi
01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01.19.2016


12/31/2015 Changes to Montana Medicaid
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
06/09/2015 National Drug Code (NDC) Billing
02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU


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
06/12/2014 ICD-10 Delay
05/13/2014 PERM Provider Educational Webinars
04/22/2014 Modifier Changes for Professional Claim Billers
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


12/23/2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update
11/26/2013 ICD-10 Readiness
11/07/2013 Radiology Procedures and Medicaid Passport to Health Referrals
11/07/2013 Podiatrists and Medicaid Passport to Health Referrals
10/08/2013 Referrals for Audiology Services
10/03/2013 Mid-Level Provider Services in a NICU Setting
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)
09/03/2013 Passport to Health Member Pending Lists and Provide Caseload Capacities
07/10/2013 Psychiatrist Service Reimbursement Change and Timely Billing Requirement
07/08/2013 Montana Medicaid DSM-5 Implementation
07/05/2013 Medicaid/HMK Plus and Sports Physicals
06/20/2013 Montana Plan First – Additional Information
05/28/2013 DPHHS to Discontinue Temporary Hotline Number
05/13/2013 Montana Plan First – Revised List of Plan First Covered Services
05/06/2013 Passport to Health Disenrollment Requirements for Providers Disenrolling a Member
02/25/2013 Vaccine Administration Changes
02/21/2013 Primary Care Enhanced Payment Program Notification
02/19/2013 Montana Medicaid HIPAA Operating Rules Upgrade
02/12/2013 BRCA1 and BRCA2 Testing Update
02/11/2013 Passport and Medical Evaluation with Psychotherapy Services
02/11/2013 Montana Plan First Additional Information Updated


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
10/02/2012 New Optometric Codes Require Prior Authorization
10/01/2012 Concurrent Outpatient Mental Health Therapy Services Reimbursed by Children’s Medicaid
09/10/2012 Preferred Drug List (PDL) Expansion
08/22/2012 Deleted ICD-9-CM Codes
06/11/2012 Plan First Effective 06.01.2012
05/01/2012 Passport and Foster Care
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


12/12/2011 Qualifier for Anesthesia Services on HIPAA 5010 837P Transactions
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
11/02/2011 Smart PA® and Prior Authorization for Synagis®
10/20/2011 Prior Authorization for Children's Vitamins
10/07/2011 Influenza Virus Vaccine
09/09/2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012
09/09/2011 DME Order and Prescription Requirements
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
06/01/2011 17-AHP and Makena
05/05/2011 Renew Passport Provider Agreement
04/12/2011 Request: Claims Submission, Date of Payment by June 30, 2011
03/23/2011 Changes to Procedure Code Indicators
02/07/2011 Vaccine Administration Code Update


11/17/2010 17-AHP
11/17/2010 Compound Drugs Billed on a CMS-1500
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
07/04/2010 Fee Schedule for Mirena
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
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
05/25/2010 Medicaid Incentive Payment Program for Adopting Electronic Health Records
03/29/2010 Implantable Neurostimulators
02/09/2010 United States 2010 Census
02/08/2010 Medicaid Health Improvement Program
02/03/2010 Medicaid Consultation Services
01/21/2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid

Provider Notices 2000–2009


10/01/2009 Healthy Montana Kids Plan
09/22/2009 NDC Billing Tools
03/16/2009 Timely Filing for Medicare Crossovers
02/26/2009 ATP Lab Fees Rev. 03.12.2009
02/12/2009 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid


10/20/2008 Changes in Transplant Coverage Rev. 10.27.2008
08/12/2008 Federal Government May Request Medical Records Rev. 09.18.2008
07/22/2008 Billing Procedures Regarding Electronic Claims (837P and 837I)
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
04/10/2008 Billing Procedures Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and 837-P
03/17/2008 Resubmission of Denied Claims Rev. 03.19.2008
03/11/2008 Billing Procedures Regarding National Drug Code (NDC) Rev. 10.15.2008
03/10/2008 NPI Reenrollment and Billing
02/04/2008 Duplicate Issue Rev. from 01.31.2008
01/29/2008 Enhanced Claims Editing—Medicare Correct Coding Initiative Edits (CCI)
01/18/2008 Possible Duplicate Claims Processed Through Electronic Data Interchange


12/26/2007 WINASAP Upgrade Required for NDC Data Collection
12/18/2007 Radiopharmaceutical Pricing 2007 Update
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 Rev. 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®
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
01/22/2007 ATP Lab Fees


12/22/2006 Prior Authorization for DMEPOS and Medical/Surgical Procedures Updated Phone and Fax Lines
11/08/2006 Prior Authorization on the Move
07/27/2006 Billing for Clients with Medicare and Medicaid – Revised
04/11/2006 ATP Lab Fees 2006
01/05/2006 Increased Reimbursement for EPSDT Preventive Services


09/26/2005 Blood Draws (CPT 36415 and 36416)
07/28/2005 Scales – Congestive Heart Failure
04/04/2005 Pricing Logic Changes for Professional (CMS-1500) Claims
02/04/2005 Introduction to Preferred Drug List
12/01/2004 Billing for Clients With Medicare and Medicaid
06/10/2004 Team Care Program A New Component of the Passport to Health Program
03/16/2004 ATP Lab Fees
12/01/2003 Bilateral X-Ray Reimbursement Update
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 Lab Panel Crosswalk
08/05/2003 ATP Lab Fees
06/01/2003 Discontinued Services That Now Require Prior Authorization
05/12/2003 Provider Rate and Payment Update
05/01/2003 Outpatient Hospital Lab Panel Update
01/29/2003 Prescription Drug Services Update
01/10/2003 New Provider Notification Procedure and Medicaid Changes
01/02/2003 Drug Prior Authorization Update


12/01/2002 Program Changes and Updates
10/01/2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time
09/26/2002 DME Update
09/01/2002 Cost Sharing
07/01/2002 2.6% Reduction
03/21/2002 Prior Authorization Reminders: DME, DMEPOS
02/14/2002 Weekly Payment Available
05/29/2001 Billing for Lab Panels
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 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.

Prior Authorization Criteria for Specific Services

Rebateable Manufacturers 04/2017

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 Thank you.