Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Mid-Level

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Mid-Level

Mid-Level Practitioner

Provider Manuals

General Information for Providers  09/2017

Medicaid manual with general information for all provider types.

Prescription Drug Program 09/27/2017

This manual has information specific to your provider type.

Passport to Health 10/2017

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

Medicaid Rules and Regulations

Fee Schedules – Mid-Level Practitioner

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

January 2017 

PDF: January 2017 Mid-Level Rev. 01/13/2017
Excel: January 2017 Mid-Level Rev. 01/13/2017

July 2016

PDF: July 2016 Mid-Level Rev. 09/13/2916
Excel: July 2016 Mid-Level Rev. 09/13/2916
TXT: July 2016 Mid-Level Rev. 09/13/2916

January 2016 

PDF: January 2016 Mid-Level Rev. 01/22/2016
Excel: January 2016 Mid-Level Rev. 01/22/2016
TXT: January 2016 Mid-Level Rev. 01/22/2016

July 2015 

PDF: July 2015 Mid-Level
Excel: July 2015 Mid-Level
TXT: July 2015 Mid-Level

January 2015 

PDF: January 2015 Mid-Level Rev. 04/16/2015
Excel: January 2015 Mid-Level Rev. 04/16/2015
TXT: January 2015 Mid-Level Rev. 04/16/2015

Fee Schedules – ATP Tests and Fees

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

January 2017 

PDF: January 2017 ATP  
Excel: January 2017 ATP
TXT: January 2017 ATP

January 2015

PDF: January 2016 ATP  
TXT: January 2016 ATP  

January 2015

PDF:
January 2015 ATP  
TXT: January 2015 ATP  

Provider Notices

Some documents on this page are legal and/or historical in nature and cannot be altered to meet 508 Accessibility standards.  Each of those documents has a corresponding .txt document with the same name placed next to it.

2017

11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments
11/13/2017 Smart PA® Prior Authorization for Synagis®
11/02/2017 New Medicare Card
10/22/2017 S1040 - Cranial Remolding Orthotic
10/04/2017 Makena Injection Code Change and Reimbursement
10/02/2017 Montana Medicaid Expansion Changes
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
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
04/21/2017 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
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
01/03/2017 New Guidelines for Outpatient Psychotherapy
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

 

2016

PDF: 12/08/2016 Physician Administered Drugs - Local Anesthetics
TXT: 12/08/2016 Physician Administered Drugs - Local Anesthetics
PDF: 11/30/2016 EnLyte®
TXT: 11/30/2016 EnLyte®
PDF: 11/21/2016 Humira Unit Submission
TXT: 11/21/2016 Humira Unit Submission
PDF: 11/21/2016 PA for Methadone
TXT: 11/21/2016 PA for Methadone
PDF: 11/10/2016 Vaccines For Children Administration Update
TXT: 11/10/2016 Vaccines For Children Administration Update
PDF: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
TXT: 11/03/2016 Smart PA® for Synagis® Revised 11/15/2016
PDF: 11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
TXT: 11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
PDF: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
TXT: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
PDF: 09/26/2016 Coverage of Weighted Blankets
TXT: 09/26/2016 Coverage of Weighted Blankets
PDF: 9/22/2016 Physician Administered Drugs Update - NDC Requirements
TXT: 9/22/2016 Physician Administered Drugs Update - NDC Requirements
PDF: 08/12/2016 Vaccine Administration by Pharmacists
TXT: 08/12/2016 Vaccine Administration by Pharmacists
PDF: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
TXT: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT: 07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/18/2016 Changes to Member Cost Share Update
TXT: 07/18/2016 Changes to Member Cost Share Update
PDF: 07/12/2016 Vaccine Administration Code Update
TXT: 07/12/2016 Vaccine Administration Code Update
PDF: 07/05/2016 PA For Botox No Longer Required
TXT: 07/05/2016 PA For Botox No Longer Required
PDF: 07/05/2016 Circumcision Prior Authorization Changes
TXT: 07/05/2016 Circumcision Prior Authorization Changes
PDF: 05/19/2016 Changes to Member Cost Share
TXT: 05/19/2016 Changes to Member Cost Share
PDF: 05/10/2016 PRTF Ancillary Services
TXT: 05/10/2016 PRTF Ancillary Services
PDF: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
TXT: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
PDF: 04/05/2016 Place of Service Code Change
TXT: 04/05/2016 Place of Service Code Change
PDF: 02/19/2016 Physician Fee Schedule Update
TXT: 02/19/2016 Physician Fee Schedule Update
PDF: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
TXT: 02/01/2016 Basic Medicaid Benefit Increased to Standard Medicaid Benefit
PDF: 01/21/2016 Important Dental Benefit Update
TXT: 01/21/2016 Important Dental Benefit Update
PDF: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01/19/2016
TXT: 01/15/2016 Standard Medicaid and HELP Plan Claims Processing Rev. 01/19/2016
PDF: 01/15/2016 Hospital Grade Electric Breast Pump Requirements
TXT: 01/15/2016 Hospital Grade Electric Breast Pump Requirements

2015

PDF: 12/31/2015 Changes to Montana Medicaid
TXT: 12/31/2015 Changes to Montana Medicaid
PDF: 12/31/2015 Important Dental Benefit Update
TXT: 12/31/2015 Important Dental Benefit Update
PDF: 12/31/2015 Increase in Passport Caseloads Due to HELP Plan
TXT: 12/31/2015 Increase in Passport Caseloads Due to HELP Plan
PDF: 12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
TXT: 12/30/2015 Addictive and Mental Disorders Division Changes to Prior Authorization
PDF: 11/27/2015 Compound Drugs Billed on CMS-1500
TXT: 11/27/2015 Compound Drugs Billed on CMS-1500
PDF: 11/23/2015 Prior Authorization Requests and Medical-Surgical Prior Authorization Request Form Rev. 12/2015
TXT: 11/23/2015 Prior Authorization Requests
PDF: 11/13/2015 Oral Nutrition for Children Under Age 21 – EPSDT
TXT: 11/13/2015 Oral Nutrition for Children Under Age 21 – EPSDT
PDF: 11/03/2015 Services Exempt from Passport to Health Referral
TXT: 11/03/2015 Services Exempt from Passport to Health Referral
PDF: 10/09/2015 Montana Plan First – ICD-10 Update
TXT: 10/09/2015 Montana Plan First – ICD-10 Update
PDF: 10/07/2015 Compound Drugs Billed on CMS-1500
TXT: 10/07/2015 Compound Drugs Billed on CMS-1500
PDF: 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
TXT: 10/01/2015 Changes to the Children's Mental Health Bureau Medicaid Services Provider Manual
PDF: 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
TXT: 08/03/2015 ICD-10 Guidance for Implementing International Classification of Diseases, 10th Edition (ICD-10)
PDF: 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
TXT: 07/31/2015 Adult and Pediatric Specialty Table of Services Available in Montana
PDF: 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
TXT: 07/08/2015 Montana Plan First – Revised List of Plan First Covered Services
PDF: 06/24/2015 Primary Care Enhanced Payment Program Ends
TXT: 06/24/2015 Primary Care Enhanced Payment Program Ends
PDF: 06/19/2015 Vaccine Administration Code Update
TXT: 06/19/2015 Vaccine Administration Code Update
PDF: 06/09/2015 National Drug Code (NDC) Billing
TXT: 06/09/2015 National Drug Code (NDC) Billing
PDF: 05/07/2015 Anesthesia and Global Service Requirement
TXT: 05/07/2015 Anesthesia and Global Service Requirement
PDF: 05/06/2015 Prior Authorization Required for Jublia® Topical Solution
TXT: 05/06/2015 Prior Authorization Required for Jublia® Topical Solution
PDF: 03/27/2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
TXT: 03/27/2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
PDF: 03/25/2015 EFT for Passport Providers
TXT: 03/25/2015 EFT for Passport Providers
PDF: 02/23/2015 New Restrictions Added to Hydrocodone-Chlorpheniramine Suspension (Tussionex®)
TXT: 02/23/2015 New Restrictions Added to Hydrocodone-Chlorpheniramine Suspension (Tussionex®)
PDF: 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU
TXT: 02/11/2015 New HCPCS Modifiers – XE, XP, XS, and XU

 

Other Resources

To locate older documents, access the Archive Page.