Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Optometric

Main Content



Provider Manuals

General Information for Providers 02/2017

Medicaid manual with general information for all provider types.

Optometric and Eyeglass Services 04/2017

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.




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: Medicaid Covered Services and Client Eligibility

Optometric and Eyeglass Services

04/10/2017 Optometric and Eyeglass Services, April 2017
In summary, the manual was updated to include current cost share language and co-pays and basic accessibility changes were made as approved by the Manuals Committee in September 2016.

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

06.24.2015 Optometric and Eyeglass Services, June 2015: Entire Manual

(Note: There are pages that have no text changes; however, the page layout is different than the previous manual due to changes on previous pages.)

08.11.2014 Entire Optometric and Eyeglass Services Manual

Information contained in the General Information for Providers manual or found elsewhere on the website has been removed, and links to those sources are included.

05.19.2010 Key Contacts and Prior Authorization

04.25.2006 Covered Services Information for Initial/New Prescriptions for Eyeglasses

10.12.2005 Covered Services Information for Initial/New Prescriptions

09.09.2005 Eyeglass Service Modifiers, New Place of Service Codes

04.18.2005 Clarification for Lens Add-Ons and Updated Key Contacts

01.19.2005 Rule References Added

04.29.2004 Updates for HIPAA, Covered Services, and Billing Procedures

07.09.2003 Covered Services

Medicaid Rules and Regulations

Fee Schedules – Optometric

Fee Schedules - Eyeglasses

12/01/2016 PDF December 2016 Eyeglasses Revised 12/15/2016 12/01/2016  EXCEL December 2016 Eyeglasses Revised 12/15/2016


Provider Notices


05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
04/06/2017 New EPSDT Request Form


1129/2016 Walman Optical Fram Warranty Procedure
10/14/2016 Eyeglass Contractor Change
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
01/13/2016 Requesting Prior Authorization from Medicaid or Healthy Montana Kids (HMK) for Certain Eyeglass Services


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

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

06/27/2014 Reimbursement Rate Changes and Terminology Change Regarding 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

Other Resources

Eyewear FAQ  04/2017
Prior Authorization 08/2015

EOB R&R Crosswalk PDF and EOB R&R Crosswalk Excel 0/.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.

Plan First Medicaid Non-Covered Agreement 07/2012

Rebateable Manufacturers 04/2017

SURS Provider Self-Audit Protocol 10/2015

To locate older documents, access the Archive Page.