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Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Physician

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Physician

Physician

Provider Manuals

General Information for Providers  

Physician-Related Services 12/2017

This manual has information specific to your provider type.

Prescription Drug Program 07/08/2019

This manual has information specific to your provider type.

Passport to Health 10/2017

Everything a provider needs to know to become a successful Passport provider.

Medicaid Rules and Regulations

Fee Schedules – Physician

Fee Schedules – ATP Tests and Fees

Provider Notices

For prescription medication notices, see the Pharmacy page/

2020

03/19/2020 Telemedicine Medicaid Coverage and Reimbursement Policy for Telemedicine/Telehealth  rev 03/27/2020
03/19/2020 Telemedicine Policy Clarification 

03/12/2020 Medical Food or Formula for Phenylketonuria (PKU) due to Inborn Errors of Metabolism (IEM) - HCPCS Code S9435
02/28/2020 Starting Dose and Quantity Limitations for Sedative Hypnotics
02/25/2020 Physician Administered Drug Update
01/24/2020 Consent for Sterilization Form
01/03/2020 Changes to Hepatitis C Treatment Criteria

2019

12/27/2019 Elimination of Copayments
12/27/2019 Prior Authorization Criteria for Atypical Antipsychotics for Children 7 Years of Age and Under
12/04/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
11/22/2019 New Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Review and
                   Process through Qualitrac Portal
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
11/14/2019 Daily Supply Kit by Day for Enteral Feeding (B4034, B4035, B4036) 
09/11/2019 Medication-Assisted Treatment (MAT) Bundled Rates
08/27/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy rev. 08/27/2019
07/23/2019 Therapeutic Continuous Glucose Monitor and Sensors – K0554 & K0553
07/10/2019 Consent for Sterilization Form
07/09/2019 Vaccine Administration by Pharmacists
06/21/2019 Electronic Prior Authorization Process for Suboxone Films for Medication Assisted Therapy
05/20/2019 Nurse Visit - Appropriate Billing Reminder - Revised Clarification rev. 05/30/2019
05/10/2019 NDC Required on All Radiopharmaceuticals
05/01/2019 Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
04/01/2019 Durable Medical Equipment Criteria for Home Ventilators 
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)
02/15/2019 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
02/15/2019 DOT Medical Examination
01/31/2019 Kyleena®, Mirena®, and Skyla® Acquisition Costs
01/17/2019 Physician Administered Drug Update
01/15/2019 Sublocade® (Injectable Extended-Release Buprenorphine)

2018

11/30/218  Dosage Restrictions for all Opioids based on Morphine Milligram Equivalents (MME)
11/26/2018 Hearing Aid Services Adjustment for Rate Reduction
11/21/2018 Physician Administered Drug Prior Authorization Form
11/20/2018 Audiology Adjustment for Rate Restoration
11/20/2018 Appropriate Billing Reminder
1/13/2018 Diabetes Prevention Program (DPP) Claims Update
11/08/2018 Rate Updates Mass Adjustment
11/06/2018 Smart PA® Prior Authorization for Synagis®
11/06/2018 Vaccine Administration by Pharmacists
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
07/24/2018 Diabetes Prevention Program (DPP) Coding Change
07/18/2018 Drugs Not Covered For MAT Members
07/17/2018 Caregiver Depression Screenings Reissued Notice
07/16/2018 Elective Deliveries Re-Issued Notice
07/05/2018 Dosage Restrictions For All Opioids Based On Morphine Milligram Equivalents (MME) - this has been replaced with the provider notice dated 11/30/2018.
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
04/25/2018 Changes to the Medicare Part D Drug Benefit for Dual Eligible Members – Benzodiazepines
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. 03/08/2018
03/02/2018 Physician Administered Drug Update
02/27/2018 DME Incontinence Supply Rates
02/26/2018 New Rendering Only Provider Enrollment Application
02/20/2018 Advanced Imaging Prior Authorization
02/12/2018 Makena Injection Code Change and Reimbursement 
01/31/2018 Montana Healthcare Programs Covered Double Electric Breast Pumps - E0603
01/30/2018 Fetal Chromosomal Aneuploidy Testing
01/30/2018 Psych Care Management New Codes 99492 - 99494
01/17/2018 Xgeva® Prior Authorization Criteria
01/12/2018 Zinplava Prior Authorization Criteria (Revised, provider types added)

Other Resources

To locate older documents, access the Archive Page.