Physician

Prior Authorization Forms Claim Jumper Newsletters

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.

For prescription medication notices, see the Pharmacy page/

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
07/01/2021 Global Surgical Package
06/11/2021 COVID-19 Vaccine Administration Billing Guidance
06/11/2021 Procedure Code 58350, Chromotubation
05/21/2021 Sterilization Consent Form MA-38 to be Discontinued
05/18/2021 Medication Assisted Treatment (MAT) Services Are Only Approved to Treat Members with an Opioid Use Disorder (OUD)
05/12/2021 Removal of DLA-20 Requirement from Transcranial Magnetic Stimulation (TMS) Services
05/05/2021 Date Spans for Prior Authorization Through the Qualitrac Portal
04/08/2021 Electronic Prior Authorization Process for Suboxone® Films for Medication Assisted Therapy
04/02/2021 New Provider Type – Licensed Marriage and Family Therapist
03/04/2021 Reference Laboratory Billing Guidelines
03/01/2020 
DME and DME EPSDT Prior Authorizations Through the Qualitrac Portal
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
11/17/2020 Prior Authorizations Through the Qualitrac Web Portal for DME and DME EPSDT
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
10/02/2020 Select P Codes Allowable in a Physician Setting for Hospital Owned Physician Clinics
10/02/2020 SINUVA® and PROPEL® (mometasone furoate) Sinus Implants
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
06/26/2020 Vaccine Administration by Pharmacists
06/18/2020 P Codes Not Allowable in a Physician Setting and Not Eligible for Reimbursement
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 

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
11/13/2018 Diabetes Prevention Program (DPP) Claims Update
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)