Department of Public Health and Human Services

Montana Healthcare Programs Provider Information » Physician

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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/


01/24/2020 Consent for Sterilization Form
01/03/2020 Changes to Hepatitis C Treatment Criteria


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)


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)


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

Other Resources

To locate older documents, access the Archive Page.