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Independent Diagnostic Testing Facilities (IDTF)


Independent Diagnostic Testing Facility

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.

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.





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
04.29.2005 Member Number a Billable Number and Key Contacts Updated
11.05.2004 References to Medicaid Rules/Regulations Added
09.16.2004 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: 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

Medicaid Rules and Regulations

Fee Schedules – Independent Diagnostic Testing Facility (IDTF)

07/2016 PDF July 2016 IDTF Rev. 07/13/2016 Excel July 2016 IDTF Rev. 07/13/2016
01/18/2016 PDF January 2016 IDTF Rev. 02/09/2016 Excel January 2016 IDTF Rev. 02/09/2016
07/2015 PDF July 2015 IDTF Excel July 2015 IDFT
01/2015 PDF January 2015 IDTF Excel January 2015 IDTF
07/2014 PDF July 2014 IDTF Excel July 2014 IDTF
02/2014  PDF January 2014 IDTF Excel January 2014 IDTF

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


05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
04/06/2017 New EPSDT Request Form
03/16/2017  Physician Administered Drugs - Update


09/27/2016 Physician Administered Drugs - NDC Requirements Revised
07/18/2016 Changes to Member Cost Share Update
05/19/2016 Changes to Member Cost Share
02/10/2016 IDTF 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


12/31/2015 Changes to Montana Medicaid
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
08/03/2015 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
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
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
03/18/2014 Information Regarding CMS-1500
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

Other Resources

EOB R&R Crosswalk and EOB R&R Crosswalk 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 04/2017

SURS Provider Self-Audit Protocol 10/2015


To locate older documents, access the Archive Page.