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Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Outpatient

Main Content

Hospital Outpatient

Hospital Outpatient

Provider Manuals

General Information for Providers  05/2019
Medicaid manual with general information for all provider types.
Hospital Outpatient Services  06/2018
This manual has information specific to your provider type.
Critical Access Hospitals 06/2018
This manual has information specific to critical access hospitals.
Passport to Health 10/2017
Everything a provider needs to know to become a successful Passport provider

Rebateable Manufacturers 10/02/2019

Medicaid Rules and Regulations

Fee Schedules – APC

Fee Schedules – ATP Tests and Fees

Fee Schedules – Clinical Laboratory (CLAB)

Fee Schedules – Outpatient Procedure (OPP) Codes

July 2019 OPPS Coversheet
July 2019 OPPS Fee Schedule PDF
July 2019 OPPS Fee Schedule Excel

April 2019 OPPS Coversheet
April 2019 OPPS Fee Schedule PDF rev. 06/26/2019
April 2019 OPPS Fee Schedule Excel  rev. 06/26/2019

January 2019 OPPS Coversheet
January 2019 OPPS Fee Schedule PDF rev. 02/18/2019
January 2019 OPPS Fee Schedule Excel  rev. 02/18/2019

 

October 2018 OPPS Coversheet 
October 2018 OPPS Fee Schedule PDF
October 2018 OPPS Fee Schedule Excel

July 2018 OPPS Coversheet Version 2
July 2018 OPPS Fee Schedule Version 2 PDF
July 2018 OPPS Fee Schedule Version 2 Excel

July 2018 OPPS Coversheet
July 2018 OPPS Fee Schedule PDF
July 2018 OPPS Fee Schedule Excel

April 2018 OPPS Cover Sheet
April 2018 OPPS Fee Schedule PDF
April 2018 OPPS Fee Schedule Excel

March 2018 OPPS Cover Sheet   rev. 04/06/2018
March 2018 OPPS Fee Schedule PDF  rev. 03/14/2018
March 2018 OPPS Fee Schedule Excel  rev. 03/14/2018

January 2018 OPPS Cover Sheet rev. 02/20/2018
January 2018 OPPS Fee Schedule PDF rev. 04/02/2018
January 2018 OPPS Fee Schedule Excel rev. 04/02/2018

October 2017

Cover Sheet Cover Sheet October 2017 OPPS Services Fee Schedule  
PDF: October 2017 OPPS Services Fee Schedule rev. 11/14/2017
Excel: October 2017 OPPS Services Fee Schedule rev. 11/15/2017

July 2017

PDF: July 2017 OPP Cover Sheet Rev 09/28/2017  July 2017 OPP Fee Schedule PDF rev. 11/14/2017
Excel: July 2017 OPP Fee Schedule Excel rev. 11/14/2017

PDF: April 2017 OPP Cover Sheet     April 2017 OPP Fee Schedule PDF    rev. 11/14/2017
Excel: April 2017 OPP Fee Schedule Excel rev. 11/14/2017

January 2017

PDF: January 2017 OPP Codes
Excel: January 2017 OPP Codes
TXT: January 2017 OPP Codes

 

Provider Notices

2019


10/01/2019 Chronic Care/Coordinated Care Codes
07/25/2019 Cognitive Care Reimbursement (Revised)
07/02/2019 Montana Plan First - Update to Covered Code List
06/11/2019 Frequently Asked Hospital Laboratory Services Questions 
06/28/2019 Cognitive Care Reimbursement
06/12/2019 Unlisted Billing Codes Reminder
05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019
05/10/2019 NDC Required on All Radiopharmaceuticals
03/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes
03/20/2019 Prior Authorization Qualitrac Portal
03/07/2019 Systematic Approval Diagnosis for MRI of the Head and CT of the Brain (Revised)
02/27/2019 Billing Multiple Same-day Visits on a UB-04 or 837I and Condition Code G0 - Re-Issued Notice
02/20/2019 Reimbursement Rate Change
02/20/2019 Telehealth Originating Site Facility Fee
02/15/2019 Systematic Approval Diagnosis for MRI of the Head and CT of the Brain
02/15/2019 Claims Processing for CT of the Brain and MRI of the Head
01/17/2019 Physician Administered Drug Update
01/15/2019 Sublocade® (Injectable Extended-Release Buprenorphine)

2018

11/21/2018 Physician Administered Drug Prior Authorization Form
11/20/2018 Appropriate Billing Reminder
1/13/2013 Diabetes Prevention Program (DPP) Claims Update
11/08/2018 Rate Updates Mass Adjustment
11/06/2018 Smart PA® Prior Authorization for Synagis®
10/19/2018 Medicaid Fee Schedules
10/09/2018 CT of the Brain and MRI of the Head Tips
10/03/2018 Vaccine for Children Code Update - Revised 
10/02/2018 MRI Brain with Contrast Radiology - revised 
10/02/2018 CT of the Brain Radiology - revised
09/24/2018 Prior Authorization for Genetics Testing for Youth Mental Health
09/18/2018 MRI of the Brain with Contrast Radiology - revised
09/18/2018 CT of the Brain Radiology - revised
08/17/2018 Update ICD-10 Obstetric Observation Diagnosis Codes
07/24/2018 Diabetes Prevention Program (DPP) Coding Change
07/17/2018 Caregiver Depression Screenings Reissued Notice
07/02/2018 Updated CLIA Claims Editing
06/12/2018 Approved Diagnosis Codes for Botox
06/04/2018 Coding Resources Change
05/30/2018 Panniculectomy Criteria
05/09/2018 OPPS/APC Fee Schedule Quarterly Update
05/01/2018 Condition Code - LARC Immediately After Delivery
04/18/2018 New AMDD Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health
04/04/2018  Updated Passport Eligible Populations & Reimbursement
03/22/2018 Criteria for Breast Reconstruction
03/15/2018 Criteria for MRI of the Brain rev. 04/10/2018
03/15/2018 Criteria for CT of the Brain rev. 04/10/2018
03/14/2018 Prior Authorization for Genetics Testing for Youth Mental Health
03/02/2018 Physician Administered Drug Update rev. 03/09/2018
02/26/2018 New Rendering Only Provider Enrollment Application
02/2/2018 Elimination of Provider-Based Clinic Status rev. 03/15/2018
02/20/2018 Advanced Imaging Prior Authorization
02/15/2018 Reimbursement Rate Change
01/31/2018 Montana Healthcare Programs Covered Double Electric Breast Pumps - E0603
01/30/2018 Fetal Chromosomal Aneuploidy Testing
01/22/2018 HCPCS code G0515 replaces 97532
01/17/2018 Xgeva® Prior Authorization Criteria
01/12/2018 Zinplava Prior Authorization Criteria (Revised, provider types added)
01/12/2018 Infertility Treatment Code-J0725

2017

12/29/2017 Prior Authorization for Transgender Mastectomy/Breast Augmentation
12/29/2017 Prior Authorization for Gender Reassignment Surgery
12/26/2017 MATH Web Portal Eligibility Inquiry Verification Update
12/26/2017 Outpatient Hospital Reimbursement Rate Change
12/18/2017 Fetal Chromosomal Aneuploidy Testing
12/11/2017  Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update
12/11/2017 Vaccines for Children Code Update
12/01/2017 Montana Medicaid Expansion Prior Authorization Changes
11/28/2017 Physician Administered Drug Prior Authorizations
11/21/2017 Severe Disabling Mental Illness (SDMI) rev. 11/22/2017
11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments
11/13/2017 Smart PA® Prior Authorization for Synagis®
11/02/2017 New Medicare Card
10/02/2017 Montana Medicaid Expansion Changes
09/25/2017 Vaccine Administration Code Update
09/19/2017 Individual Adjustment Request Form on Split Claims
09/14/2017 Montana Plan First Anesthesia Update
08/21/2017 Clinical Pharmacist Practitioner
08/01/2017 Telemedicine - Correction
07/25/2017 Physician Administered Drugs - Update - NDC Requirements
07/25/2017 Physician Administered Code Update - Procedure Codes Rev. 07/26/2017
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
07/03/2017 Clinical Pharmacist Practitioner
05/01/2017 Vaccine Administration Code Update
04/24/2017 Unlisted Services or Procedures Reminder
04/20/2017 Plan First Hysterectomy codes added effective April 1, 2017
04/06/2017 New EPSDT Request Form
03/16/2017  Physician Administered Drugs - Update
02/02/2017 EPSDT ( Children's) Lead Screening Requirements
02/02/2017 Change to Medicaid Outpatient Lab Billing

 

Other Resources

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