Ambulatory Surgical Center Ambulatory Surgical Center Prior Authorization Forms Claim Jumper Newsletters Provider Manuals General Information for Providers 05/2019 Medicaid manual with general information for all provider types. Ambulatory Surgical Center Services 04/2019 This manual has information specific to your provider type. Medicaid Rules and Regulations Code of Federal Regulations (Title 42) Montana Code Annotated - https://leg.mt.gov/ (Choose “Laws & Bills” then “ Montana Statutes – MCA”) Applicable Section: Title 53, Chapter 6 Administrative Rules of Montana (Title 37) Chapter 79 Healthy Montana Kids Chapter 82 Medicaid Eligibility Chapter 83 Medicaid for Certain Medicare Beneficiaries and Others Chapter 85 General Medicaid Services Chapter 86 Medicaid Primary Care Services Fee Schedules – Ambulatory Surgical Center (ASC) October 2019 ASC Coversheet October 2019 ASC Fee Schedule PDF October 2019 ASC Fee Schedule Excel July 2019 ASC Coversheet July 2019 ASC Fee Schedule PDF July 2019 ASC Fee Schedule Excel April 2019 ASC Coversheet April 2019 ASC Fee Schedule PDF April 2019 ASC Fee Schedule Excel January 2019 ASC Coversheet January 2019 ASC Fee Schedule PDF January 2019 ASC Fee Schedule Excel October 2018 ASC Coversheet October 2018 ASC Fee Schedule PDF October 2018 ASC Fee Schedule Excel July 2018 ASC Coversheet Version 2 July 2018 ASC Fee Schedule Version 2 PDF July 2018 ASC Fee Schedule Version 2 Excel July 2018 ASC Coversheet July 2018 ASC Fee Schedule PDF July 2018 ASC Fee Schedule Excel April 2018 Coversheet April 2018 Fee Schedule PDF April 2018 Fee Schedule EXCEL January 2018 ASC Coversheet January 2018 ASC Fee Schedule January 2018 PDF rev. 04/02/2018 ASC Fee Schedule January 2018 Excel rev. 04/02/2018 October 2017 PDF: ASC Fee Schedule October 2017 Cover Sheet: ASC Fee Schedule Cover Sheet Excel: ASC Fee Schedule October 2017 Excel July 2017 PDF: ASC Fee Schedule July 2017 PDF Cover Sheet: ASC Fee Schedule Cover Sheet Excel: ASC Fee Schedule July 2017 Excel April 2017 PDF: ASC Fee Schedule Definitions PDF: ASC Fee Schedule April 2017 PDF Excel: ASC Fee Schedule April 2017 Excel January 2017 PDF: January 2017 ASC Excel: January 2017 ASC TXT: January 2017 ASC 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. 2019 10/01/2019 Chronic Care/Coordinated Care Codes 07/25/2019 Cognitive Care Reimbursement (Revised) 07/10/2019 Consent for Sterilization Form 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 3/25/2019 Montana Plan First - Change to Covered Procedures and Service Codes 03/20/2019 Prior Authorization Qualitrac Portal 2018 11/21/2018 Physician Administered Drug Prior Authorization Form 11/20/2018 Appropriate Billing Reminder 11/13/2013 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 07/02/2018 Updated CLIA Claims Editing 06/04/2018 Coding Resources Change 05/30/2018 Panniculectomy Criteria 04/04/2018 Updated Passport Eligible Populations & Reimbursement 03/22/2018 Criteria for Breast Reconstruction 02/26/2018 New Rendering Only Provider Enrollment Application 2017 02/20/2018 Advanced Imaging Prior Authorization 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 12/11/2017 Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update 12/01/2017 Montana Medicaid Expansion Prior Authorization Changes 11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments 11/02/2017 New Medicare Card 10/02/2017 Montana Medicaid Expansion Changes 09/14/2017 Montana Plan First Anesthesia Update 08/21/2017 Clinical Pharmacist Practitioner 08/01/2017 Telemedicine - Correction 05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition 0 4/06/2017 New EPSDT Request Form 03/07/2017 Reminder: Billing for Services in ASCs Other Resources Prior Authorization Criteria for Specific Services Rebateable Manufacturers 10/02/2019 SURS Provider Self-Audit Protocol 10/2015 To locate older documents, access the Archive Page.