Physician Physician 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. 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 Code of Federal Regulations (Title 42) Montana Code Annotated (Title 53, Chapter 6) Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services 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/ 2017 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 2016 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 2015 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 2014 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 Prior Authorization Criteria for Specific Services Rebateable Manufacturers 07/2017 SURS Provider Self-Audit Protocol 10/2015 To locate older documents, access the Archive Page.