Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Psychiatrist

Main Content

Psychiatrist

Psychiatrist

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.

Mental Health Services – Adult 03/2017

This manual has information specific to your provider type.

Mental Health Services – Children 10/2015

This link brings you to Manuals and Guides on the Department website.

Prescription Drug Program 12/2016

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.

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
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

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”.

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: Entire Manual

07.08.2014 Multiple Chapters

07.25.2006 Well-Child EPSDT Update

07.14.2006 Key Contacts, Completing a Claim Form, Prior Authorization, Billing for Immunizations

04.25.2006 Revised Instructions for Completing a Claim, Revised Information on How Cost-Sharing Affects Claim Payment

01.05.2006 New EPSDT, Hysterectomy Acknowledgement Form, Revised Information on Imaging Modifiers, Billing for Immunizations, and ER Visits for Clients under Age 2

03.01.2005 Hysterectomy Acknowledgement Update

01.25.2005 Rule References Added, Updates to Covered Services, PA and Modifiers

11.16.2004 Updated Prescription Drug PA Criteria

09.15.2004 Team Care Added

06.16.2004 Clarification on Sterilizations, Hysterectomies, Abortions and HIPAA and Drug PA Update

12.23.2003 Immunizations, PA Criteria, Family Planning, and Using Modifiers

09.16.2003 Hysterectomies and Prescription Drug PA Update

08.20.2003 New Emergency Services Policy and Hard Card Information

07.28.2003 Hysterectomy Requirements

06.01.2003 New PA Requirements and Hysterectomy Information

01.02.2003 Prior Authorization

09.01.2002 Cost Sharing

Mental Health Services Adult

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”.

   
   

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

Medicaid Rules and Regulations

Fee Schedules – Psychiatrist

PDF   EXCEL  
01/09/2017 January 2017 Psychiatrist Rev. 01/13/2017 01/09/2017 January 2017 Psychiatrist Rev. 01/13/2017
07.2016 July 2016 Psychiatrist  Rev. 08.22.2016 07.2016 July 2016 Psychiatrist  Rev. 08.22.2016
01.18.2016 January 2016 Psychiatrist Rev. 01.22.2016 01.18.2016 January 2016 Psychiatrist Rev. 01.22.2016
07.2015 July 2015 Psychiatrist Rev. 11.06.2015 07.2015 July 2015 Psychiatrist Rev. 11.06.2015
04.2015 January 2015 Psychiatrist Rev. 11.03.2015 04.2015 January 2015 Psychiatrist Rev. 11.03.2015
02.2015 July 2014 Psychiatrist 02.2015 July 2014 Psychiatrist
02.2015 January 2014 Psychiatrist 02.2015 January 2014 Psychiatrist
07.2009 July 2009 Psychiatrist 07.2009 July 2009 Psychiatrist
07.2003 July 2003 Psychiatrist 07.2003 July 2003 Psychiatrist
07.2002 July 2002 Psychiatrist 07.2002 July 2002 Psychiatrist
07.2001 July 2001 Psychiatrist 07.2001 July 2001 Psychiatrist

Fee Schedules – 72-Hour Presumptive

Fee Schedules – ATP Tests and Fees

PDF
01/17/2017 January 2017 ATP
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 04.2006
03.2004 January 2004 ATP 01.2005

Fee Schedules – Medicaid Mental Health

Fee Schedules – Mental Health Service Plan (MHSP)

Provider Notices 2010–

2017

03/16/2017  Physician Administered Drugs - Update
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

2016

12/15/2016 Billing and Code Clarification for Psychotherapy and Psychiatric Diagnostic Services
12/08/2016 Physician Administered Drugs - Local Anesthetics
11/01/2016 ICD 10 Updates and Coding Changes Revised 12/07/2016
09/27/2016 Physician Administered Drugs - NDC Requirements Revised
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
07.18.2016 Changes to Member Cost Share Update
05.19.2016 Changes to Member Cost Share
05.10.2016 PRTF Ancillary Services
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

2015

12.31.2015 Changes to Montana Medicaid
12.30.2015 Addictive and Mental Disorders Division Changes to Prior Authorization
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
08.10.2015 Requesting Additional Therapy Sessions and Exception to 24 Sessions Request Form
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
06.09.2015 National Drug Code (NDC) Billing
03.27.2015 Initial Prescription Fill Requirements for Attention Deficit Hyperactive Disorder Stimulant Drugs
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 Update
12.01.2014 Billing and Code Clarification for Individual and Family Therapy on the Same Day
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
06.12.2014 ICD-10 Delay
05.13.2014 PERM Provider Educational Webinars
04.22.2014 Modifier Changes for Professional Claim Billers
03.18.2014 Information Regarding CMS-1500
02.06.2014 Interactive Audio and Video Mental Health Services for Licensed Psychologists, LCPCs, and LCSWs
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

2013

12.23.2013 Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Changes Update
11.26.2013 ICD-10 Readiness
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 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
05.28.2013 DPHHS to Discontinue Temporary Hotline Number
02.19.2013 Montana Medicaid HIPAA Operating Rules Upgrade
02.11.2013 Passport and Medical Evaluation with Psychotherapy Services

2012

12.26.2012 Medicaid/HMK Plus Toll-Free Number
08.22.2012 Deleted ICD-9-CM Codes
01.06.2012 Psychiatric Residential Treatment Facility (PRTF) Prior Authorization Start Date Must Match Admission Date

2011

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
09.09.2011 HIPAA 5010.OCR Qualifier Changes Effective January 1, 2012
09.07.2011 Payment Error Rate Measurement (PERM)
08.16.2011 Care Coordination Is Available on a Limited Basis for Youth in a Psychiatric Residential Treatment Facility
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
04.12.2011 Request: Claims Submission, Date of Payment by June 30, 2011
04.12.2011 Prior Authorization for Cycloset®
04.12.2011 Prior Authorization for Pradaxa®
04.12.2011 Prior Authorization for Nexiclon®
02.23.2011 Prior Authorization for Abstral®

2010

10.05.2010 Changes to NCCI Edits
07.28.2010 Provider Record Update Procedures
06.23.2010 Cost Sharing Exemption under ARRA
06.22.2010 Electronic Health Records Link
02.09.2010 United States 2010 Census
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

10.01.2009 Healthy Montana Kids Plan

03.16.2009 Timely Filing for Medicare Crossovers

03.05.2009 Vagus Nerve Stimulation (VNS) 03.10.2009

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

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

04.10.2008 Billing Procedures Regarding National Drug Code (NDC) for Providers Using the CMS-1500 and 837-P

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

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

12.26.2007 WINASAP Upgrade Required for NDC Data Collection

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

12.03.2007 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®

08.01.2007 Elimination of eSOR

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

01.26.2007 Mental Health Claims May Have Been Underpaid

01.22.2007 ATP Lab Fees

2001–2005

04.11.2006 ATP Lab Fees

03.20.2006 15-Day Supply Limit Clinical Edit on Initial Atypical Antipsychotic Prescriptions

01.05.2006 Increased Reimbursement for EPSDT Preventive Services

09.26.2005 Blood Draws (CPT 36415 and 36416)

09.22.2005 Telemedicine

07.28.2005 Scales – Congestive Heart Failure

04.04.2005 Pricing Logic Changes for Professional (CMS-1500) Claims

02.04.2005 Introduction to Preferred Drug List

10.01.2004 Emergency Department Claims Appeal Process

06.10.2004 Prior Authorization Additions Pharmacy, Physician, Mid-Level

06.10.2004 Team Care Program A New Component of the Passport to Health Program

03.16.2004 ATP Lab Fees 2004

01.22.2004 Lab and Radiology Services Covered Under MHSP Plan

12.23.2003 Chemical Dependency Procedure Code Changes

12.01.2003 High Risk Pregnant Women (HRPW) Changes

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

07.25.2003 MHSP Pharmacy Changes

07.01.2003 Mental Health Program Changes and Fees

06.01.2003 Discontinued Services That Now Require Prior Authorization

05.28.2003 Change in Reimbursement for Interactive Psychotherapy

05.01.2003 Outpatient Hospital Lab Panel Update

03.01.2003 Pharmacy Prior Authorization and Refill Changes

03.01.2003 Nutrition Services Require Passport Approval

01.29.2003 Prescription Drug Update

01.10.2003 New Provider Notification Procedure and Medicaid Changes

01.02.2003 Drug Prior Authorization Updates

10.01.2002 Billing for Medicare Crossovers After Medicare's 45-Day Response Time

09.01.2002 Cost Sharing

06.20.2002 Passport to Health 24-Hour Availability

02.14.2002 Weekly Payment Available

01.26.2001 New Definitions for SED and SDMI

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

Prior Authorization Criteria for Specific Services

Rebateable Manufacturers 01/2017

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.