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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.

Mental Health Services – Adult 03/2017

This manual has information specific to your provider type.

Mental Health Services – Children 10/2015

See the CMHB section of the Plans and Publications page on the DPHHS website.

Passport to Health 11/2015

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

Prescription Drug Program 11/2016

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
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, October 2014: Billing Procedures
07.22.2014 General Information for Providers, July 2014:Member Eligibility and Responsibilities
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 2014: Team Care and Nurse First Information Added

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

07.08.2014 Physician-Related Services, July 2014: Multiple Chapters

03.14.2008 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, August 2003: Hysterectomy Requirements

06.01.2003 Physician-Related Services, June 2003: 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

Prescription Drug Program

12/27/2016 In summary, the Cost Share section of the Billing Procedures chapter was updated and the Cover Page was updated with the current date.

11/15/2016 In summary, the Reimbursement Chapter has some revised language changes, the whole Prescription Drug Manual has been reformatted with changes approved for all manuals in September 2016, and the Cover page was updated with the most recent modification date

06.27.2016 Prescription Drug Program, July 2016: In summary, the Reimbursement for Covered Drugs and FMAC were modified, Average Acquisition Cost and Submitted Ingredient Cost sections were added, and the Estimated Acquisition Cost section was removed from Chapter 6, Reimbursement. The Table of Contents was updated and the Cover Page was amended to reflect the effective date.

06.15.2016 Prescription Drug Program, July 2016: Cost Share Updates

12.31.2015 Prescription Drug Program, January 2016: HELP Plan-Related Updates and Others

07.21.2015 Prescription Drug Program, Prior Authorization, Reimbursement, and Billing Procedures

03.25.2015 Prescription Drug Program, Entire Manual

09.27.2013 Prescription Drug Program, Reimbursement

09.05.2013 Prescription Drug Program, Entire Manual Including the New Passport Chapter
This set of replacement pages contains a terminology change ("client" to "member"); however, only content changes are marked with a change bar (black line).

04.17.2013 Prescription Drug Program, Key Contacts and Reimbursement

02.04.2013 Prescription Drug Program, Medicaid Covered Products

02.01.2012 Prescription Drug Program, Multiple Chapters

09.01.2011 Prescription Drug Program, Medicaid Covered Services and Reimbursement (Dispensing Fee) and MHSP Covered Products (Formulary Drugs)

06.17.2011 Prescription Drug Program
Entire manual has changed from last posted version.

11.16.2004 Prescription Drug Program, Updated Prescription Drug Prior Authorization Criteria

06.16.2004 Prescription Drug Program, Prior Authorization and HIPAA Updates

06.10.2004 Prior Authorization Additions

Mental Health - Adult

2017

03/16/2017 In summary, some minor changes were made to language on the code chart on page 10.

08.25.2016 In Summary, the Cost Share section on pages 4 and 5 was removed and replaced with a referral to the general manual, and the index was adjusted to reflect impacted page numbers.

06.08.2016 Mental Health - Adult July 2016 In summary, the Cover Page date was changed and the Index was amended to replace  “Basic” and “Full” Medicaid to “Standard Medicaid”

Passport to Health

11.09.2015 Passport to Health, November 2015: Passport Referrals

Medicaid Rules and Regulations

Fee Schedules – Physician

PDF Excel
01/09/2017 January 2017 Physician Rev.01/13/2017 01/09/2017 January 2017 Physician Rev.01/13/2017
07.2016 July 2016 Physician Rev. 09/13/2016 07.2016 July 2016 Physician Rev. 09/13/2016
01.18.2016 January 2016 Physician Rev. 03.24.2016 01.18.2016 January 2016 Physician Rev. 03.242016
08.04.2015 July 2015 Physician Rev. 08.04.2015 July 2015 Physician Rev.
04.16.2015 January 2015 Physician Rev. 04.16.2015 January 2015 Physician Rev.
07.2014 July 2014 Physician Rev. 07.2014 July 2014 Physician Rev.
02.2014 January 2014 Physician Rev. 02.2014 January 2014 Physician Rev.
12.2013 December 2013 Physician 12.2013 December 2013 Physician
07.2013 July 2013 Physician 12.2013 07.2013 July 2013 Physician 12.2013
01.2013 January 2013 Physician 01.2013 January 2013 Physician
07.2012 July 2012 Physician FY 2013 07.2012 July 2012 Physician FY 2013
01.2012 January 2012 Physician 01.2012 January 2012 Physician
11.2011 September 2011 Physician 11.2011 September 2011 Physician
02.2011 January 2011 Physician 02.2011 January 2011 Physician
07.2010 July 2010 Physician 07.2010 July 2010 Physician
02.2010 January 2010 Physician 02.2010 January 2010 Physician
07.28.2009 July 2009 Physician Rev. 07.28.2009 July 2009 Physician Rev.
04.27.2009 January 2009 Physician Rev. 04.27.2009 January 2009 Physician Rev.
07.2008 July 2008 Physician 07.2008 July 2008 Physician
01.2008 January 2008 Physician 01.2008 January 2008 Physician
10.2007 October 2007 Physician 10.2007 October 2007 Physician
01.2007 January 2007 Physician 01.2007 January 2007 Physician
01.2006 January 2006 Physician 01.2006 July 2006 Physician

Fee Schedules – 72-Hour Presumptive

Fee Schedules – ATP Tests and Fees

PDF

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

Fee Schedules – Medicaid Mental Health

Adults 18 and Over, PDF

07.2016 July 2016 Medicaid Mental Health for Adults

12.17.2015 January 2016 Medicaid Mental Health for Adults Revised 12.24.2015

07.2015 July 2015 Medicaid Mental Health for Adults

07.2014 July 2014 Medicaid Mental Health for Adults

07.2013 July 2013 Medicaid Mental Health for Adults

01.2013 January 2013 Medicaid Mental Health for Adults

08.2012 July 2012 Medicaid Mental Health for Adults

08.2010 August 2010 Medicaid Mental Health for Adults

07.2008 July 2008 Medicaid Mental Health for Adults

10.2007 October 2007 Medicaid Mental Health for Adults

11.2006 November 2006 Medicaid Mental Health for Adults

07.2006 July 2006 Medicaid Mental Health for Adults

07.2004 July 2004 Medicaid Mental Health for Adults

07.2003 July 2003 Medicaid Mental Health for Adults

Youth Under 18, PDF

01/04/2017 January 2017 Medicaid Mental Health for Youth

11/22/2016 Integrated Co-Occurring Treatment Fees

06.08.2016 July 2016 Medicaid Mental Health for Youth

09.28.2015 October 2015 Medicaid Mental Health for Youth

07.2015 July 2015 Medicaid Mental Health for Youth

01.2015 January 2015 Medicaid Mental Health  for Youth

07.2014 July 2014 Medicaid Mental Health for Youth

03.2014 January 2014 Medicaid Mental Health for Youth

07.2013 July 2013 Medicaid Mental Health for Youth

08.2012 July 2012 Medicaid Mental Health  for Youth

09.2011 September 2011 Medicaid Mental Health for Youth

01.2011 January 2011 Medicaid Mental Health for Youth

08.2010 July 2010 Medicaid Mental Health for Youth

Fee Schedules – Mental Health Services Plan (MHSP)

Provider Notices 2010–

For prescription medication notices, see the Pharmacy page.

2017

05/01/2017 Vaccine Administration Code Update
04/24/2017 Unlisted Services or Procedures Reminder
04/21/2017 Bowl 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
11/21/2016 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
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 Primary Care Enhanced Payment Program Notification
11.07.2013 Medicaid Passport to Health Referrals and Fee Schedules
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 Passport to Health Member Pending Lists and Provide Caseload Capacities
09.03.2013 Changes to Contract with Magellan Medicaid Administration (MMA)
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

2012

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
08.22.2012 Deleted ICD-9-CM Codes
06.11.2012 Plan First Effective June 1, 2012
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

2011

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
05.18.2011 Dentist and Denturist Program Manual Updated
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

2010

10.05.2010 Changes to NCCI Edits
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
02.09.2010 United States 2010 Census
02.01.2010 ATP Fees 2010
   
01.21.2010 Reimbursement Change for Psychiatric Residential Treatment Facilities and How It Affects Other Montana Medicaid Providers

Provider Notices 2000–2009

2009

12.10.2009 Billing and Code Clarification for Psychological Testing and Request to Adjust Claims by December 31, 2009
10.08.2009 2009 H1N1 Influenza Vaccine and Administration 10.15.2009
10.07.2009 Quantity Limits on Ostomy Products
10.01.2009 Healthy Montana Kids Plan
09.29.2009 Update: SmartPA® Prior Authorization for Synagis®
09.22.2009 NDC Billing Tools
09.10.2009 First DataBank, Medi-Span, and McKesson AWP Litigation Settlements: Pharmacy Reimbursements May Be Impacted by Upcoming Reporting Change
07.16.2009 Coverage of Fluoride Varnish
07.08.2009 Anesthesia Providers
06.02.2009 Clarification of Required NDC Information for Coverage of 17 Alpha-Hydroxyprogesterone Caproate (17-AHP)
04.27.2009 Transplant Program Update 04.30.2009
03.16.2009 Timely Filing for Medicare Crossovers
03.05.2009 Vagus Nerve Stimulation (VNS) 03.10.2009
02.26.2009 ATP Lab Fees 2009 03.12.2009
02.25.2009 Vaccines for Children (VFC) Effective as of October 10, 2008
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 10.27.2008
09.03.2008 Tamper-Resistant Rx Pad Update: Three Features Required October 1
09.02.2008 Introducing SmartPA®
08.12.2008 Federal Government May Request Medical Records 09.18.2008
07.22.2008 Billing Procedures Regarding Electronic Claims (837P and 837I)
07.11.2008 Changes in Mental Health Services Plan for Adults Age 18 and Older
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 06.17.2008
05.21.2008 Maintenance Medications, Pharmacy Dispensing Fee Increase, and Signature Log Requirements
05.01.2008 RHC.FQHC Taxonomy on Provider Encounters in Hospitals
04.10.2008 Billing Procedures Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and 837-P
04.01.2008 Preferred Drug List (PDL): Brand Products No Longer Preferred Over Generics 05.12.2008
03.17.2008  Resubmission of Denied Claims 03.19.2008
03.11.2008 Billing Procedures Regarding National Drug Code (NDC) 10.15.2008
03.10.2008 NPI Reenrollment and Billing
02.20.2008 Changes to Prior Authorization for Circumcision 08.05.2008
02.19.2008 New HCPCS.CPT Codes
02.13.2008 Tamper-Resistant Prescription Pads
02.04.2008 Duplicate Issue Updated from 01.31.2008
01.29.2008 Enhanced Claims Editing—Medicare Correct Coding Initiative Edits (CCI)
01.28.2008 Expansion of Provider Types for the Mental Health Services Plan
01.22.2008 Passport to Health Caseloads to Increase
01.18.2008 Possible Duplicate Claims Processed Through Electronic Data Interchange
01.11.2008 Vaccines for Children (VFC)

2007

12.28.2007 New Codes for Smoking and Tobacco Use Cessation Counseling
12.26.2007 WINASAP Upgrade Required for NDC Data Collection
12.21.2007 Compound Prescription Billing Changes 01.16.2008
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
12.11.2007 Sports Physicals
12.03.2007 NPI Requirement for Fee-for-Service Healthcare Provider Claims
11.30.2007 NDC Requirement on All Physician-Administered Drugs 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®
10.03.2007  VFC Update
10.03.2007 Rendering Provider
10.01.2007 Tamper-Resistant Prescription Pads – Postponed
09.28.2007 Smoking and Tobacco Use Cessation Counseling
09.20.2007 Tamper-Resistant Prescription Pads – Updated
08.27.2007  Vaccines for Medicare Part D Participants
08.07.2007 Tamper-Resistant Prescription Pad Requirement
08.01.2007 Elimination of eSOR
07.06.2007 Coverage of 17 Alpha-Hydroxyprogesterone Caproate
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
04.16.2007 VFC Update Updated from 01.24.2007
04.16.2007 Coverage of HPV Vaccine
03.08.2007 New and Deleted Codes
03.08.2007 Cardiac and Pulmonary Rehabilitation No Longer Require a Prior Authorization for Outpatient Settings
02.01.2007 Adjustments to Anesthesia Claims
01.26.2007 Mental Health Claims May Have Been Underpaid
01.22.2007 ATP Lab Fees 2007

2006

12.22.2006 Prior Authorization for DMEPOS and Medical/Surgical Procedures Updated Phone and Fax Lines
11.08.2006 Prior Authorization on the Move
10.04.2006 Change in Reimbursement of the -QY Modifier
09.22.2006 VFC Update
07.27.2006 Billing for Clients with Medicare and Medicaid – Revised
04.18.2006 VFC Update
04.11.2006 ATP Lab Fees 2006
03.01.2006 VFC Update
02.10.2006 New and Deleted Codes
01.05.2006 Increased Reimbursement for EPSDT Preventive Services

2005

12.28.2005 Montana Medicaid Provider Website Now Offers Online Medical History
12.02.2005 Coverage of Drugs for Sexual and Erectile Dysfunction Eliminated
10.11.2005 Wheelchair CMNs – Transition Instructions
09.26.2005 Blood Draws (CPT 36415 and 36416)
09.22.2005 Telemedicine
07.28.2005 Scales – Congestive Heart Failure
07.01.2005 Revised Processing for Emergency Room Visits
07.01.2005 VFC Update
06.01.2005 Medicaid Coverage Update
04.04.2005 Pricing Logic Changes for Professional (CMS-1500) Claims
03.01.2005 Hysterectomy Acknowledgement Update
02.04.2005 Introduction to Preferred Drug List
02.01.2005 New and Deleted Codes and New Botox Criteria

2004

12.01.2004 Billing for Clients with Medicare and Medicaid
10.01.2004 Emergency Department Claims Appeal Process
06.10.2004 Team Care Program A New Component of the Passport to Health Program
06.01.2004 Important Reminder Regarding Sterilizations, Hysterectomies and Abortions
04.27.2004 Observation Bed Criteria – Updated
03.16.2004 ATP Lab Fees 2004
02.01.2004 New and Deleted Codes
01.22.2004 Lab and Radiology Services Covered Under MHSP Plan
01.01.2004 VFC Changes Updated from 12.2003
01.01.2004 New and Discontinued Optometric Codes

2003

12.08.2003 ED Claim Review Procedure
12.01.2003 Bilateral X-Ray Reimbursement Update
12.01.2003 High Risk Pregnant Women (HRPW) Changes
12.01.2003 VFC Changes
12.01.2003 Discontinued Local Codes
11.10.2003 EMTALA Policy Change
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 ATP Lab Panel Fees 2003
08.05.2003 Lab Panel Crosswalk
08.05.2003 Observation Bed Criteria
07.31.2003 Passport and Emergency Services
06.01.2003 Discontinued Services That Now Require Prior Authorization
05.28.2003 Change in Reimbursement for Interactive Psychotherapy
05.12.2003 Provider Rate and Payment Update
05.01.2003 Outpatient Hospital Lab Panel Update
04.30.2003 Gastric Bypass Surgeries and Circumcisions
03.01.2003 New and Deleted HCPCS.CPT Codes
03.01.2003 Nutrition Services Require Passport Approval
01.27.2003 Optometric Program Update
01.10.2003 New Provider Notification Procedure and Medicaid Changes

2000–2002

12.01.2002 Program Changes and Updates
10.07.2002 Presumptive Eligibility
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
07.01.2002 Passport Provider Approval Update
06.20.2002 Passport to Health 24-Hour Availability
03.21.2002 Prior Authorization Reminders: DME, DMEPOS
02.14.2002 Weekly Payment Available
10.17.2001 Dental Implants
05.29.2001 Billing for Lab Panels
06.01.2001 Global Surgery Periods Effective July 1, 2001
03.20.2000 Global Surgery Periods Effective May 1, 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.

Lab Panels 2007 01.2007
List of codes that make up lab panels for 2004–2007

Notice for Surgery Following Mastectomy 11.2003
All health plans that cover mastectomies must also cover reconstructive surgery.

Plan First Medicaid Non-Covered Agreement 07.2012

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 mttpl@xerox.com. Thank you.

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