General Information for Providers  

Medicaid manual with general information for all provider types.

Rural Health Clinic 

This manual has information specific to your provider type.

Prescription Drug Program, Prior Authorization 

Prior authorization requirements and procedures are covered in this chapter.

Passport to Health 

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

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

For prescription medication notices, see the Pharmacy page/

2021

01/11/2021 Provider Support Services Closed for Martin Luther King Day, Monday, January 18, 2021
01/05/2021 FQHC and RHC Requirements

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
11/12/2020 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
10/08/2020 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
08/28/2020 Provider Relief Fund General Allocation rev. 08/28/2020

• Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/28/2020

08/11/2020 Provider Relief Fund General Allocation rev. 08/11/2020

• Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers rev. 08/11/2020

07/27/2020 Montana Plan First - Additional Covered Code, COVID - Testing
07/24/2020 Provider Relief Fund General Allocation

• Overview and Access Guide for Seeking Provider Relief Funding from HHS Allocation to Medicaid Providers

07/20/2020 Outpatient Psychotherapy Limits
07/17/2020 Medicaid Reimbursement and Court Ordered Services
07/09/2020 Medicare Telehealth Requirement – Procedure Code G2025
06/17/2020 National Correct Coding Initiative Announcement
06/11/2020 Substance Use Disorder Billing Reminder
05/15/2020 Temporary Revision to Case Management General Provisions
05/01/2020 Telephone Services – Revenue Code 982
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

04/22/2020 Suspension of Prior Authorizations or Continued Stay Reviews and Clinical Requirements for Some Medicaid Programs

• FAQ for Suspension of Prior Authorizations or Continued Stay Reviews and Clinic Requirements for Some Medicaid Programs

04/22/2020 Dental Telemedicine Notice
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 

• Frequently Asked Questions on Telemedicine / Telehealth

02/25/2020 Physician Administered Drug Update
02/20/20 Peer Support Services Revenue Code Update
01/10/2020 Co-Payment Assessed in Error for January 6, 2020

01/03/2020 Changes to Hepatitis C Treatment Criteria

2019

2018

11/20/2018 Appropriate Billing Reminder
11/13/2018 Diabetes Prevention Program (DPP) Claims Update
11/08/2018 Rate Updates Mass Adjustment
11/08/2018 Rate Updates Mass Adjustment
10/19/2018 Medicaid Fee Schedules
10/03/2018 Vaccine for Children Code Update - Revised
07/24/2018 Diabetes Prevention Program (DPP) Coding Change
07/17/2018 Caregiver Depression Screenings Reissued Notice
07/02/2018 Updated CLIA Claims Editing
06/04/2018 Coding Resources Change
05/24/2018 Reimbursement for LARCs
04/24/2018 Substance Use Disorder Treatment CPT Code Update rev. 05/09/2018
04/18/2018 New AMDD Medicaid Services Provider Manual for Substance Use Disorder and Adult Mental Health
04/04/2018  Updated Passport Eligible Populations & Reimbursement
03/02/2018 Physician Administered Drug Update rev. 03/08/2018
03/02/2018 Physician Administered Drug Update
02/26/2018 New Rendering Only Provider Enrollment Application
02/21/2018 TCM Social Determinant Diagnosis Code Update
02/20/2018 Substance Use Disorder CPT Code Update
01/31/2018 Montana Healthcare Programs Covered Double Electric Breast Pumps - E0603
01/17/2018 Xgeva^® Prior Authorization Criteria
01/12/2018 Zinplava Prior Authorization Criteria (Revised, provider types added)
01/12/2018 Infertility Treatment Code-J0725

SURS Provider Self-Audit Protocol 10/2015