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Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Hospital Outpatient

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Hospital Outpatient

Hospital Outpatient

Provider Manuals

General Information for Providers 06/2018
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 10/2018

Medicaid Rules and Regulations

Fee Schedules – APC

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.

October 2018 APC Coversheet
October 2018 APC Fee Schedule PDF
October 2018 APC Fee Schedule Excel

 

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

July 2018 APC Coversheet
July 2018 APC Fee Schedule PDF
July 2018 APC Fee Schedule Excel

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

March 2018 APC Cover Sheet
March 2018  APC Fee Schedule PDF
March 2018 APC Fee Schedule Excel

January 2018 APC Cover Sheet
January 2018 APC Fee Schedule PDF
January 2018 APC Fee Schedule Excel

 

October 2017

Cover Sheet Cover Sheet October 2017 APC Services Fee Schedule
PDF: October 2017 APC Services Fee Schedule
Cover Sheet Cover Sheet October 2017 APC Services Fee Schedule

Excel: October 2017 APC Services Fee Schedule

July 2017

PDF: July 2017 APC Cover Sheet   July 2017 APC Fee Schedule PDF 
Excel: July 2017 APC Fee Schedule Excel

April 2017

PDF: April 2017 APC Cover Sheet   April 2017 APC Fee Schedule PDF
Excel: April 2017 APC Fee Schedule Excel

January 2017

PDF: January 2017 APC
Excel: January 2017 APC
TXT: January 2017 APC

October 2016

PDF:  October 2016 APC
ExcelOctober 2016 APC
TXT: October 2016 APC

July 2016

PDF: July 2016 APC
Excel:  July 2016 APC
TXT: July 2016 APC

April 2016

PDF: April 2016 APC 
Excel: April 2016 APC
TXT: April 2016 APC

January 2016

PDF: January 2016 APC Rev 04/26/2016
Excel: January 2016 APC Rev 04/26/2016
TXT: January 2016 APC Rev 04/26/2016

 

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.

July 2018 ATP Fee Schedule
January 2018 ATP Fee Schedule

January 2017

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

January 2016

PDF: January 2016 ATP  
TXT: January 2016 ATP

 

Fee Schedules – Clinical Laboratory (CLAB)

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.

July 2018 Laboratory Services Coversheet Version 2
July 2018 Laboratory Services Fee Schedule Version 2 PDF
July 2018 Laboratory Services Fee Schedule Version 2 Excel 

July 2018 Laboratory Services Coversheet
July 2018 Laboratory Services Fee Schedule PDF
July 2018 Laboratory Services Fee Schedule Excel

January 2018 Laboratory Services Cover Sheet
January 2018 Laboratory Services PDF rev 2/15/2018
January 2018 Laboratory Services Excel rev 215/2018

 

PDF: January 2017 Lab and Imaging Rev. 01/13/2017
Excel: January 2017 Lab and Imaging Rev. 01/13/2017
TXT: January 2017 Lab and Imaging Rev. 01/13/2017

 

PDF: July 2016 Lab and Imaging Rev. 08/22/2016
Excel: July 2016 Lab and Imaging Rev. 08/22/2016
TXT: July 2016 Lab and Imaging Rev. 08/22/2016

 

PDF: January 2016 Lab and Imaging Rev. 01/22/2016
Excel: January 2016 Lab and Imaging Rev. 01/22/2016
TXT: January 2016 Lab and Imaging Rev. 01/22/2016

 

Fee Schedules – Outpatient Procedure (OPP) Codes

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.

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

October 2016

PDF: October 2016 OPP Codes
Excel: October 2016 OPP Codes
TXT: October 2016 OPP Codes

July 2016

PDF: July OPP Codes Rev 07/26/2016
Excel:  July OPP Codes Rev 07/26/2016
TXT: July OPP Codes Rev 07/26/2016

April 2016

PDF: April OPP Codes Rev 07/11/2016
Excel: April 2016 OPP Codes  Rev 07/11/2016
TXT: April OPP Codes Rev 07/11/2016

January 2016

PDF: January 2016 OPP Codes Rev 05/12/2016
Excel:  January 2016 OPP Codes Rev 05/12/2016
TXT: January 2016 OPP Codes Rev 05/12/2016

 

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.

2018

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

2016

PDF: 12/08/2016 Physician Administered Drugs - Local Anesthetics
TXT:  12/08/2016 Physician Administered Drugs - Local Anesthetics
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: 09/27/2016 Physician Administered Drugs - NDC Requirements Revised
TXT:  09/27/2016 Physician Administered Drugs - NDC Requirements Revised
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT:  07/28/2016 Montana Plan First Preventive Code Additions
PDF: 07/25/2016 Admission Date and Statement Covers Period - Revised
TXT:  07/25/2016 Admission Date and Statement Covers Period - Revised
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: 07/01/2016 Admission Date and Statement Covers Period
TXT:  07/01/2016 Admission Date and Statement Covers Period
PDF: 05/19/2016 Changes to Member Cost Share
TXT:  05/19/2016 Changes to Member Cost Share
PDF: 04/07/2016 Montana Plan First - IUD and Anesthesia Updates
TXT:  04/07/2016 Montana Plan First - IUD and Anesthesia Updates
PDF: 04/05/2016 Place of Service Code Change
TXT:  04/05/2016 Place of Service Code Change
PDF: 03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims
TXT:  03/21/2016 NDC Required for Physician-Administered Drugs: Billing Instructions for Montana Medicaid Crossover Claims
PDF: 03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016
TXT:  03/02/2016 ICD-10 Obstetric Observation Billing Update Revised 03/01/2016
PDF: 02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials
TXT:  02/22/2016 Hospital NDC Billing on Revenue Codes and Electronic Claim Submission Denials
PDF: 02/10/2016 ICD-10 Obstetric Observation Billing Update
TXT:  02/10/2016 ICD-10 Obstetric Observation Billing 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: 01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
TXT:  01/28/2016 LARC Inserted at Time of Delivery in PPS Hospital
PDF: 01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes
TXT:  01/25/2016 Hospital National Drug Code (NDC) Billing on Revenue Codes
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

 

Other Resources

To locate older documents, access the Archive Page.