Hospital Outpatient

Prior Authorization Forms Claim Jumper Newsletters

General Information for Providers 
Medicaid manual with general information for all provider types.
Hospital Outpatient Services  
This manual has information specific to your provider type.
Critical Access Hospitals 
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 07/01/2021

April 2021 APC Coversheet
April 2021 APC Fee Schedule PDF
April 2021 APC Fee Schedule Excel

January 2021 APC Coversheet
January 2021 APC Fee Schedule PDF
January 2021 APC Fee Schedule Excel

October 2020 APC Coversheet
October 2020 APC Fee Schedule PDF
October 2020 APC Fee Schedule Excel

July 2020 APC Coversheet
July 2020 APC Fee Schedule PDF rev. 07/22/2020
July 2020 APC Fee Schedule Excel rev. 07/22/2020

April 2020 APC Coversheet
April 2020 APC Fee Schedule PDF
April 2020 APC Fee Schedule Excel

January 2020 APC Coversheet
January 2020 APC Fee Schedule PDF
January 2020 APC Fee Schedule Excel

October 2019 APC Coversheet
October 2019 APC Fee Schedule PDF
October 2019 APC Fee Schedule Excel

 

July 2019 APC Coversheet
July 2019 APC Fee Schedule PDF
July 2019 APC Fee Schedule Excel

April 2019 APC Coversheet
April 2019 APC Fee Schedule PDF
April 2019 APC Fee Schedule Excel

 

January 2019 APC Coversheet
January 2019 APC Fee Schedule PDF
January 2019 APC Fee Schedule Excel

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

 

April 2021 OPPS Cover Sheet 
April 2021 OPPS Fee Schedule PDF rev. 06/30/2021
April 2021 OPPS Fee Schedule Excel rev. 06/30/2021

January 2021 OPPS Cover Sheet 
January 2021 OPPS Fee Schedule PDF 
January 2021 OPPS Fee Schedule Excel 

October 2020 OPPS Coversheet
October 2020 OPPS Fee Schedule PDF rev. 12/04/2020
October 2020 OPPS Fee Schedule Excel rev. 12/04/2020

July 2020 OPPS Coversheet
July 2020 OPPS Fee Schedule PDF rev. 11/05/2020
July 2020 OPPS Fee Schedule Excel rev. 11/05/2020

April 2020 OPPS Cover Sheet 
April 2020 OPPS Fee Schedule PDF 
April 2020 OPPS Fee Schedule Excel

January 2020 OPPS Cover Sheet 
January 2020 OPPS Fee Schedule PDF rev. 08/31/2020
January 2020 OPPS Fee Schedule Excel rev. 08/31/2020

October 2019 OPPS Coversheet
October 2019 OPPS Fee Schedule PDF
October 2019 OPPS Fee Schedule Excel

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

 

2021

09/28/2021 Laboratory Panel Billing
09/24/2021 Codes Removed from and Added to Plan First Covered Code List
09/23/2021 Prior Authorization Criteria for Synagis®
09/16/2021 Billing Update - Licensed Marriage and Family Therapist (LMFT)
09/16/2021 Off-Label Use of Ketamine
07/30/2021 Updated Criteria for ENTYVIO (vedolizumab)
07/20/2021 Fetal Chromosomal Aneuploidy Testing
07/20/2021 Enrollment Update – Licensed Marriage and Family Therapist
07/13/2021 Prior Authorization Required for Lemtrada
07/06/2021 Adoption Of Temporary Emergency Rule To Allow for COVID-19-Related
Regulatory Discretion Beyond The Expiration Of The Governor-Declared State Of Emergency
07/06/2021 Procedure Code 58350, Chromotubation
06/11/2021 COVID-19 Vaccine Administration Billing Guidance 
05/21/2021 Sterilization Consent Form MA-38 to be Discontinued
05/05/2021 Date Spans for Prior Authorization Through the Qualitrac Portal
04/02/2021 
New Provider Type – Licensed Marriage and Family Therapist
03/04/2021 Reference Laboratory Billing Guidelines
01/28/2021 Montana Healthcare Programs Support Services Holiday Closures
01/27/2021 Vaccines for Children (VFC) Code Update
01/21/2021 Montana Plan First Additional Codes Added to Plan First Covered Code List
01/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021

2020

12/23/2020 Diabetes Prevention Program (DPP) Information
12/07/2020 Medicaid Expansion Extended Through December 31, 2021 
12/01/2020 Change in Application Process for Plan First
11/25/2020 Physician Administered Drug (PAD) Prior Authorization Requests Revised
11/12/2020 Removal of Codes for COVID-19 Testing and Treatment
11/10/2020 Prior Authorization Criteria for Synagis®
10/28/2020 Provider Relief Fund General Allocation
10/19/2020 Discarded Drugs and Biologicals and the Use of the JW Modifier
10/08/2020 Montana Plan First - Addition of Radiologic Examination Codes for Abdomen; 1, 2, and 3 Views
10/02/2020 Reimbursement for CPT Code 90694 FLUAD Quadrivalent
09/24/2020 Updated ICD-10 Obstetric Observation Diagnosis Codes
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020

08/10/2020 Physician Administered Drug (PAD) Prior Authorization Requests - Revised
07/27/2020 Montana Plan First - Additional Covered Code, COVID - Testing
07/24/2020 Provider Relief Fund General Allocation

07/20/2020 Outpatient Psychotherapy Limits
07/17/2020 Medicaid Reimbursement and Court Ordered Services
06/17/2020 National Correct Coding Initiative Announcement
05/15/2020 Temporary Revision to Case Management General Provisions
04/30/2020 National Correct Coding Initiative Announcement
04/28/2020 Temporary Suspension of the PCP Referral Requirement
04/27/2020 Non-Covered Services Agreement Policy Change
04/23/2020 Elimination of Prior Authorization and Criteria Requirements for MRI of the Head and CT of the Brain

04/22/2020 Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs


04/01/2020 Suspension of Face to Face Requirements for Some Medicaid Programs
03/19/2020 Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth  rev 03/27/2020
03/19/2020 Telemedicine Policy Clarification 

02/25/2020 Physician Administered Drug Update
01/24/2020 Consent for Sterilization Form
01/10/2020 Co-Payment Assessed in Error for January 6, 2020

2019

12/27/2019 Elimination of Copayments
11/22/2019 New Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Review and
                   Process through Qualitrac Portal
11/18/2019 New UR Introduction and Training Information
11/18/2019 HCPCS Modifiers - XE, XS, and XU (Reissued Notice)
11/15/2019 Chronic Care/Coordinated Care Codes Revised
11/14/2019 Prior Authorization Criteria for Synagis®
11/14/2019 Circumcision Prior Authorization Changes Re-Issued from 2016
07/02/2019 Montana Plan First - Update to Covered Code List
06/11/2019 Frequently Asked Hospital Laboratory Services Questions 
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
11/13/2018 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