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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 06/2018

Medicaid manual with general information for all provider types. 

Physician-Related Services 12/2017

This manual has information specific to your provider type.

Prescription Drug Program 07/31/2018

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

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

July 2018 Physician Coversheet
July 2018 Physician Fee Schedule PDF
July 2018 Physician Fee Schedule Excel

January 2018 Physician Coversheet  rev. 02/18/2018
Physician Fee Schedule January 2018 PDF   rev. 06/05/2018
Physician Fee Schedule January 2018 Excel rev. 03/30/2018


January 2017

PDF: January 2017 Physician Rev.01/13/2017
Excel:  January 2017 Physician Rev.01/13/2017

July 2016

PDF: July 2016 Physician Rev. 09/13/2016
Excel: July 2016 Physician Rev. 09/13/2016
TXT: July 2016 Physician Rev. 09/13/2016

January 2016

PDF: January 2016 Physician Rev. 03/24/2016
Excel: January 2016 Physician Rev. 03/242016
TXT: January 2016 Physician Rev. 03/242016

 

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  

 

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.

For prescription medication notices, see the Pharmacy page/

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®
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)
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)

2017


12/29/2017 Prior Authorization for Transgender Mastectomy/Breast Augmentation
12/29/2017 Prior Authorization for Gender Reassignment Surgery
12/28/2017 Zinplava Prior Authorization Criteria
12/26/2017 MATH Web Portal Eligibility Inquiry Verification Update
12/18/2017 Fetal Chromosomal Aneuploidy Testing
12/11/2017  Montana Plan First Procedure and Service Codes - Contraceptive (IUD) Update
12/12/2017 Medication Authorization Change Regarding New Brand Name Drugs
12/11/2017 Vaccines for Children Code Update
12/06/2017 New Shingles Vaccination
12/01/2017 Montana Medicaid Expansion Prior Authorization Changes
11/29/2017 Prosthetic Devices
11/28/2017 Physician Administered Drug Prior Authorizations
11/21/2017 Severe Disabling Mental Illness (SDMI) rev. 11/22/2017
11/21/2017 Bi-Level Positive Airway Pressure Devices (Bi-Pap)
11/20/2017 Qualified Medicare Beneficiary (QMB) Claim Adjustments
11/13/2017 Smart PA® Prior Authorization for Synagis®
11/02/2017 New Medicare Card
11/02/2017 Physician Administered Drugs - Famotidine
10/04/2017 Makena Injection Code Change and Reimbursement
10/02/2017 Montana Medicaid Expansion Changes
09/25/2017 Vaccine Administration Code Update
09//14/2017 Montana Plan First Anesthesia Update
09/05/2017 Medication Authorization Changes  Rev. 09/21/2017
08/31/2017 S1040 Cranial Remolding Orthotic
08/21/2017 Clinical Pharmacist Practitioner
08/14/2014 Medication Authorization Changes
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
07/25/2017 Caregiver Depression Screenings
07/03/2017 Clinical Pharmacist Practitioner
05/26/2017 Federal Final Rule, "Nondiscrimination in Health Program and Activities” and Implication for Coverage of Services Related to Gender Transition
05/01/2017 Vaccine Administration Code Update
04/24/2017 Unlisted Services or Procedures Reminder
04/21/2017 Bowel Management Program Supplies
04/20/2017  Plan First Hysterectomy codes added effective April 1, 2017
04/11/2017  Medication Authorization Changes
04/06/2017 New EPSDT Request Form
04/05/2017 New Form to Document Need for Orthognathic Surgery
04/04/2017 PA Criteria for Artificial Disc Replacement
04/04/2017 Criteria for Orthognathic Surgery
04/04/2017 Changes to Medical Surgical PA
04/04/2017 Criteria for Panniculectomy
03/31/2017  Ketone Test Strips - A4250 & A252
03/16/2017  Physician Administered Drugs - Update
03/07/2017  Reminder: Billing for Services in ASCs
02/07/2017 New Place of Service for Telehealth
01/13/2017 Update to January 2017 Fee Schedules
01/13/2016 Audiology Referrals and Physician Authorization for Hearing Aids
02/02/2017 EPSDT ( Children's) Lead Screening Requirements

2016

PDF: 12/08/2016 Physician Administered Drugs - Local Anesthetics
TXT: 12/08/2016 Physician Administered Drugs - Local Anesthetics
PDF: 11/30/2016 EnLyte®
TXT: 11/30/2016 EnLyte®
PDF: 11/21/2016 Humira Unit Submission 1
TXT: 11/21/2016 Humira Unit Submission 1
PDF: 1/21/2016 PA for Methadone
TXT: 1/21/2016 PA for Methadone
PDF: 11/10/2016 Vaccines For Children Administration Update
TXT: 11/10/2016 Vaccines For Children Administration Update
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: 09/26/2016 Coverage of Weighted Blankets
TXT: 09/26/2016 Coverage of Weighted Blankets
PDF: 09/22/2016 Physician Administered Drugs Update - NDC Requirements
TXT: 09/22/2016 Physician Administered Drugs Update - NDC Requirements
PDF: 08/12/2016 Vaccine Administration by Pharmacists
TXT: 08/12/2016 Vaccine Administration by Pharmacists
PDF: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
TXT: 08/12/2016 Removal of 15-day Supply Limit on Initial Atypical Antipsychotic Prescriptions
PDF: 07/28/2016 Montana Plan First Preventive Code Additions
TXT: 07/28/2016 Montana Plan First Preventive Code Additions
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: 05/19/2016 Changes to Member Cost Share
TXT: 05/19/2016 Changes to Member Cost Share
PDF: 05/10/2016 PRTF Ancillary Services
TXT: 05/10/2016 PRTF Ancillary Services
PDF: 04/07/2016 Montana Plan First - IUD and Anesthesia Updates
TXT: 04/07/2016 Montana Plan First - IUD and Anesthesia Updates
PDF: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
TXT: 04/06/2016 Hepatitis C Prior Authorization Streamlined Request Form
PDF: 04/05/2016 Place of Service Code Change
TXT: 04/05/2016 Place of Service Code Change
PDF: 02/19/2016 Physician Fee Schedule Update
TXT: 02/19/2016 Physician Fee Schedule 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: 01/15/2016 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.