Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Physician

Main Content



Provider Manuals

General Information for Providers 09/2017

Medicaid manual with general information for all provider types. 

Physician-Related Services 11/2016

This manual has information specific to your provider type.

Prescription Drug Program 12/2016

This manual has information specific to your provider type.

Passport to Health 11/2015

Everything a provider needs to know to become a successful Passport provider.

Medicaid Rules and Regulations

Fee Schedules – Physician

01/09/2017 PDF January 2017 Physician Rev.01/13/2017 Excel January 2017 Physician Rev.01/13/2017
07/2016 PDF July 2016 Physician Rev. 09/13/2016 Excel July 2016 Physician Rev. 09/13/2016
01/18/2016 PDFJanuary 2016 Physician Rev. 03/24/2016 Excel January 2016 Physician Rev. 03/242016
08/04/2015 PDF July 2015 Physician Rev. Excel July 2015 Physician Rev.
04/16/2015  PDF January 2015 Physician Rev. ExcelJanuary 2015 Physician Rev.
07/2014  PDF July 2014 Physician Rev. Excel July 2014 Physician Rev.
02/2014 PDF January 2014 Physician Rev. Excel January 2014 Physician Rev.

Fee Schedules – ATP Tests and Fees

01/17/2017  PDF January 2017 ATP  EXCEL January 2017 ATP
12/24/2015 January 2016 ATP  
01/2015 January 2015 ATP  
01/2014 January 2014 ATP      

Provider Notices

For prescription medication notices, see the Pharmacy page/


09/25/2017 Vaccine Administration Code Update
09//14/2017 Montana Plan First Anesthesia Update
09/05/2017 Medication Authorization Changes  Rev. 09/21/2017
08/31/2017 S1040 Cranial Remolding Orthotic
08/21/2017 Clinical Pharmacist Practitioner
08/14/2014 Medication Authorization Changes
08/01/2017 Telemedicine - Correction
07/25/2017 Physician Administered Drugs - Update - NDC Requirements
07/25/2017 Physician Administered Code Update - Procedure Codes Rev. 07/26/2017
07/25/2017 Caregiver Depression Screenings
07/03/2017 Clinical Pharmacist Practitioner
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
05/01/2017 Vaccine Administration Code Update
04/24/2017 Unlisted Services or Procedures Reminder
04/21/2017 Bowel Management Program Supplies
04/20/2017  Plan First Hysterectomy codes added effective April 1, 2017
04/11/2017  Medication Authorization Changes
04/06/2017 New EPSDT Request Form
04/05/2017 New Form to Document Need for Orthognathic Surgery
04/04/2017 PA Criteria for Artificial Disc Replacement
04/04/2017 Criteria for Orthognathic Surgery
04/04/2017 Changes to Medical Surgical PA
04/04/2017 Criteria for Panniculectomy
03/31/2017  Ketone Test Strips - A4250 & A252
03/16/2017  Physician Administered Drugs - Update
03/07/2017  Reminder: Billing for Services in ASCs
02/07/2017 New Place of Service for Telehealth
01/13/2017 Update to January 2017 Fee Schedules
01/13/2016 Audiology Referrals and Physician Authorization for Hearing Aids
02/02/2017 EPSDT ( Children's) Lead Screening Requirements


12/08/2016 Physician Administered Drugs - Local Anesthetics
11/30/2016 EnLyte®
11/21/2016 Humira Unit Submission 1
1/21/2016 PA for Methadone
11/10/2016 Vaccines For Children Administration Update
11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
09/27/2016 Physician Administered Drugs - NDC Requirements Revised
09/26/2016 Coverage of Weighted Blankets
09/22/2016 Physician Administered Drugs Update - NDC Requirements
08/12/2016 Vaccine Administration by Pharmacists
08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
07/28/2016 Montana Plan First Preventive Code Additions
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
05/19/2016 Changes to Member Cost Share
05/10/2016 PRTF Ancillary Services
04/07/2016 Montana Plan First - IUD and Anesthesia Updates
04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
04/05/2016 Place of Service Code Change
02/19/2016 Physician Fee Schedule Update
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
01/15/2016 Hospital Grade Electric Breast Pump Requirements


12/31/2015 Changes to Montana Medicaid

12/31/2015 Increase in Passport Caseloads Due to HELP Plan
12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
11/27/2015 Compound Drugs Billed on CMS-1500
11/23/2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev. 12/2015
11/13/2015 Oral Nutrition for Children Under Age 21 – EPSDT
11/03/2015 Services Exempt from Passport to Health Referral
10/21/2015 SmartPA® Prior Authorization for Synagis®
10/09/2015 Montana Plan First – ICD-10 Update
10/07/2015 Compound Drugs Billed on CMS-1500
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
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
06/24/2015 Primary Care Enhanced Payment Program Ends
06/19/2015 Vaccine Administration Code Update
06/09/2015 National Drug Code (NDC) Billing
05/07/2015 Anesthesia and Global Service Requirement
05/06/2015 Prior Authorization Required for Jublia® Topical Solution
03/27/2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
03/25/2015 EFT for Passport Providers
03/11/2015 Criteria for Breast Reconstruction
03/11/2015 Criteria for Prophylactic Mastectomy
02/23/2015 New Restrictions Added to Hydrocodone-Chlorpheniramine Suspension (Tussionex®)
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
12/10/2014 Primary Care Enhanced Payment Extended
12/01/2014 Billing and Code Clarification for Individual and Family Therapy on the Same Day
11/24/2014 DME Order and Prescription Requirements
10/08/2014 Vaccine Administration Code Update
09/16/2014 Adoption of the New Children's Mental Health Bureau's Medicaid Provider Manual into Administrative Rules of Montana
08/22/2014 Tobacco Cessation Products
08/05/2014 Montana Prescription Drug Registry
06/25/2014 Elective Deliveries – Mid-Level Practitioners and Physicians
06/12/2014 ICD-10 Delay
06/06/2014 Changes to Prior Approval Requirement for Makena (Code J1725)
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
01/28/2014 Vaccine Administration Code Update

Other Resources

To locate older documents, access the Archive Page.