Montana medicaid fee schedule. 00 - - - - - - - - - - .

Montana medicaid fee schedule 05 H0045 HD Respite Care - Assisted Living diem $179. By adapting the Medicare model to the needs of the Montana Medicaid program, the Department was able to take advantage of the research performed by the federal government and national associations of physicians and other Montana Healthcare Programs APC Fee Schedule Explanation Effective October 1, 2024 Definitions: Conversion Factor: Montana Medicaid Conversion Factor $60. Department of Health and Human Services and published at 86 Federal . O. 97 H0045 UA Respite Care - Nursing Facility diem *Medicaid H2015 UA Consultative Clinical and Therapeutic Services service $380. Anes Value: Number of anesthesia base value units. 2 Fees: Medicaid fee; not determined using RBRVS payment schedule . Individuals 18 years of age and older Fee Schedule Effective July 1, 2023. 75 Montana Medicaid Fee Schedule Dialysis Clinics July 1, 2024 Revenue Code Description Fee 821 Hemodialysis/composite rate or other rate $281. RE: TN 24-0009. TC = technical component . 81 Yellowstone River Nursing & Rehab Billings $278. 86 841 Continuous Ambulatory Peritoneal Dialysis (CAPD)/ *Physician Fee Schedules **Medicaid Nursing Facility Rates 651 Routine Home Care 1-60 days $ 203. 00 - - - - - - - - CY2025 Medicare Physician Fee Schedule Final Rule Montana Primary Care Association Monthly CFO Peer Group Meeting. 02 $22. 92 H0045 UA Respite Care - Assisted Living diem $175. Nicole Moscatelli, CHFP, Senior Manager. 02 831 Peritoneal/composite rate or other rate $271. Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes: A4326 - MALE EXTERNAL CATHETER 1/1/2023 MEDICARE $12. RBRVS: Based on Medicare Relative Value Units (RVU’s) x Montana Medicaid conversion factor x policy adjuster. 86 851 Continuous Cycling Peritoneal Dialysis (CCPD)/ visit Fee Sched $ 63. Agencies A-Z Programs & Services. Method: Office Fees Facility Fees Global Days PA. You must refer to the appropriate official CPT or HCPCS Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc . NA: Individuals 18 years of age and older Fee Schedule Effective July 1, 2023. 3ML 2ND - - - Fee Schedule $40. 32 $59. 32 - 000 999 - Montana Medicaid - Fee Schedule Personal and Commercial Transportation July 1, 2023 Proc Modifier Description Effective Method Fee PA Notes--PERSONAL MILAGE: 7/1/2023 FEE SCHED : $0. A4550 - SURGICAL TRAYS 7/1/2019 RBRVS $0. TS = Montana Healthcare Programs Elderly and Physically Disabled – Big Sky Waiver Services Fee Schedule Explanation . 72 - 000 999 - A4222 - INFUSION SUPPLIES WITH PUMP 1/1/2022 1/1/2023 Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services October 1, 2024 Proc Cd 2024 APC Status Ind Proc Desc Proc Modifier APC APC Weight Method -Medicare $1,200. 54 - 000 999 - Montana Healthcare Programs Optometric Fee Schedule Explanation . 12/19/2024 IRS Tax Identification Letter Required for Pay-To Providers 12/06/2024 Coverage for Botox (onabotulinumtoxinA) REVISED 12/04/2024 Change in the Double Electric Breast Pump Provider 11/04/2024 Paper Claim Denials 10/30/2024 Beyfortus and Synagis Coverage for July 2024 Physical Therapy Coversheet July 2024 Physical Therapy Fee Schedule PDF July 2024 Physical Therapy Fee Schedule Excel January 2024 Cover Sheet Physical Therapy Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes 05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered 05/13 Montana Healthcare Programs APC Fee Schedule Explanation Effective April 1, 2024 Definitions: Conversion Factor: Montana Medicaid Conversion Factor $58. Secondary Modifier Final Effective July 1, 2024 Effective: Method Unit: Maximum S5150 Respite 7/1/2024 FEE SCHED 15 minutes $ 6. Effective July 1, 2020 . 00 $720. This is added to the 15 min. 86 841 Continuous Ambulatory Peritoneal Dialysis (CAPD)/ composite rate or other rate $281. Description: Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Medicaid fee; not determined using RBRVS payment schedule . 40 831 Peritoneal/composite rate or other rate $283. 93 - - Y - Notes-Prior Authorization is required on all services listed within the HCBS SDMI fee schedule excluding H0032 Case Management. Hospital Lab Fees Min Age Max Age Comments 0001A. Fee Schedule: Medicaid fee for listed code. NA: Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services July 1, 2024 Proc Mod Description Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes: A4206-1 CC STERILE SYRINGE&NEEDLE : 7/1/2018 MSRP: $0. Chicago, Illinois 60601 . Description Effective Method Fees PA; A0080 --Non-Emergency Transportation - per mile: 10/1/2008 Fee Sched $ 0. You must refer to the appropriate official CPT or HCPCS Montana Healthcare Programs Fee Schedule Oral Surgeon Services July 1, 2023 Proc. 00 - - - - - - - - - - Adult Medicaid Mental Health Fee Schedule Effective 07/01/2022 Medicaid Mental Health Services Individuals 18 years of age and older Fee Schedule Acute care hospital services will be reimbursed for Medicaid members under the Montana Medicaid program’s Diagnosis Related Group (DRG) reimbursement system. Mod Description Effective Method of information contained in the fee schedules. 73 H0045 UA Respite Care - Nursing Facility diem *Medicaid Montana Healthcare Programs Fee Schedule Nursing Facility Medicaid Rate Effective July 1, 2024 . Practitioners’ bill using standard Current Montana Healthcare Programs Fee Schedule Laboratory Services January 1, 2023 Proc Mod Description. Fee Schedule Revenue Code Description Amount 100 Hospital Room and Board $5,083. 40 841 Continuous Ambulatory Peritoneal Dialysis (CAPD)/ composite rate or other rate $283. 59 - 000 999 - A4217 - STERILE WATER/SALINE, 500 ML 1/1/2023 MEDICARE $3. Effective July 1, 202 1 . 8364 $ 136. H0032 UA Case Management day $12. 85. Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services April 1, 2023 Proc Cd 2023 APC Status Ind Proc Desc Proc Medicare $1,200. 106 - medicaid behavioral health targeted case management fee schedule 2025. 00 By Report Equals a Percentage of Billed Charges 1 Fees as of July 1999. 00 - - - - - - - - - - A4342 - IDUC VALVE SPLY REPL 4/1/2023 MEDICARE $819. Montana Medicaid fee for Physical Therapy, Occupational Therapy or Speech and Montana Healthcare Programs Fee Schedule Dental Services July 1, 2024 Proc Mod Description Effective Method Fees PA Min Age Max age Notes 000 999 Members with Full Medicaid; 1 every 5 years D2920 - DENTAL RECEMENT CROWN 7/1/2024 FEE SCHED $57. 00 270 Medical/Surgical Supplies $719. 48 . 22 - 000 999 Members with Full Montana Healthcare Programs Fee Schedule Public Health Services Proposed July 1, 2024 Proc Mod Description Effective Method Office Fees Facility Fees E0677 RR NON PNEUM SEQ COMP TRUNK 4/1/2023 MEDICARE $76. 00 - - - - - - - - - - - A4342 - IDUC VALVE SPLY REPL Montana Healthcare Programs Fee Schedule Physical Therapy Services Proposed January 1, 2025. 75 N/A N/A 651 Montana Healthcare Programs Speech Therapy Fee Schedule Explanation . Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc Mod Description Unit Fee H0032 UA HD Case Management day $12. 40 851 Continuous Cycling Peritoneal Dialysis (CCPD)/ Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Based on Relative Value for Dentists (RVD) Montana Medicaid Dental Conversion Factor. Assist: CoSurg. You must refer to the appropriate official CPT or HCPCS indicate that there has been no fee change since that date. S. Montana Medicaid – Fee Schedule Eyeglasses May 1, 2024: Proc Modifier Description Effective Method Fee PA: V2020: VISION SVCS FRAMES PURCHASES : 5/1/2024 FEE SCHED : $14. Modifier Montana Healthcare Programs Fee Schedule Personal Assistance Services July 1, 2022 Proc Mod Mod. 34 Aspen Meadows Billings $283. The public can review the proposed January 1, 2024 and July 1, 2024 fee schedules on the Medicaid Provider Proposed Fee Schedule page. 33 - S5126 - - Community Supports Services; 7/1/2022 Fee Sched $ 5. 233 North Michigan Ave. Center for Medicaid & CHIP Services . All out-of-state admissions of Medicaid members require prior authorization Montana Medicaid 4. Team: Policy Adjust. 40 - - 000 999 Fee Schedule: Medicaid fee for listed code. 1) (room & board) per day $38. Montana Medicaid fee for Physical Therapy, Occupational Therapy or Speech and Montana Healthcare Programs Fee Schedule School-Based Health Services July 1, 2024 Proc Mod Description Effective Method Office Fees PA Policy Adj T1000 - PRIVATE DUTY/INDEPENDENT NSG 7/1/2024 FEE SCHED $10. All out-of-state admissions of Medicaid members require prior au thorization Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services January 1, 2023 Proc Cd 2022 APC Status Ind Proc Desc Proc Modifier APC APC Weight Method. * Nursing Facility Medicaid rate can be found at: Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services CORRECTED - Proposed July 1, 2023 Proc Mod Description Effective Corrected Effective Date Method A4221 - SUPP NON-INSULIN INF CATH/WK 1/1/2022 1/1/2023 MEDICARE MEDICARE $23. Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Medicaid fee; not determined using RBRVS payment schedule . 40 Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc . 11 Y >16 Miles A0140 - NONEMERGENCY TRANSPORT BASE 7/1/2023 FEE SCHED $14. The Montana Facility Fee Schedule is intended to guide the direct Individuals 18 years of age and older Fee Schedule Effective July 1, 2020 Acute Inpatient Services Acute care hospital services will be reimbursed for Medicaid members under the Montana Medicaid program’s Diagnosis Related Group (DRG) reimbursement system. Montana Medicaid - Fee Schedule Home and Community Based Services (HCBS) for Adults with Severe Disabling Mental Illness (SDMI) Effective July 1, 2022 . 28 $24. Providers serving Medicaid enrollees are reimbursed for covered services billed to the Department of Public Health and Human Services (department). City ; Medicaid Rate . Description; Effective Method Office Fees Facility Fees; A4561 - PESSARY RUBBER, ANY TYPE 1/1/2023 MEDICARE $27. * Nursing Facility Medicaid rate can be found at: https://medicaidprovider. MSRP: Manufacturers Suggested Retail Price (MSRP): Equals a percentage of billed charges based on MSRP or the provider Montana Medicaid – Fee Schedule Eyeglasses May 1, 2024: Proc Modifier Description Effective Method Fee PA: V2020: VISION SVCS FRAMES PURCHASES : 5/1/2024 FEE SCHED : $14. 00 Y--- PER DIEM: HOTEL; 7/1/2023 FEE SCHED ; $43. Proposed Effective January 1, 2022 . 54 $3. Conversion factor for fiscal year 20x is $23 35. 86 831 Peritoneal/composite rate or other rate $281. Description . 00: V2025: EYEGLASSES DELUX FRAMES 5/1/2024: FEE SCHED $24. 97 - 000 999 - A4327 - FEM URINARY COLLECT DEV CUP 1/1/2023 MEDICARE $59. Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service . " Resource based relative value scale (RBRVS) " means the version of the Medicare resource based relative value scale contained in the physicians' Medicare Physician Fee Schedule This is the first date of service for which the listed fee is applicable. 40 - - 000 999 0002M; Q LIVER DIS 10 ASSAYS W/ASH--- Medicare $839. Procedure code short description, you must refer to the appropriate official CPT, HCPCS or CDT coding manual for complete definitions . 74 - - - - - July 2024 Physical Therapy Coversheet July 2024 Physical Therapy Fee Schedule PDF July 2024 Physical Therapy Fee Schedule Excel January 2024 Cover Sheet Physical Therapy January Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes 05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc . 02 841 Continuous Ambulatory Peritoneal Dialysis (CAPD)/ composite rate or other rate $271. Financial Management Group . 97598 - DBRDMT OPN WND ADDL 20CM/< 7/1/2023 RBRVS $34. Medicaid Provider Rate Adjustments 2025 BIENNIUM. 08 $0. 2 Montana Healthcare Programs Fee Schedule Mid-Level Services Effective July 1, 2023 Proc. Montana has adopted some of the codes and processes of the Centers for Medicare and Medicaid Services (CMS), but the Montana Codes Annotated (MCA) and ARM) govern the application of these codes and processes in Montana for Workers’ Compensation (WC) reimbursement. 75 Medicaid fee; not determined using RBRVS payment schedule . July 1, 2023 . 00 Y - A0380 - BASIC LIFE SUPPORT MILEAGE 7/1/2024 FEE SCHED $4. Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services April 1, 2021 Proc Cd 2019 APC Status Ind Proc Desc Proc Modifier APC APC Weight Method Outpatient Hospital Fee Schedule Sole Comm. 50 $0. Attn: Mary Eve Kulawik The Department’s fee schedule rate for private Montana Medicaid Enrollment Requirements for In-Training Mental Health Professionals 12/20/2024. Conversion factor for fiscal year 2025 is Fee Schedule: Medicaid fee for listed code. 34 Y--- PER DIEM: EACH MEAL; 7/1/2023 FEE SCHED ; $6. Codes noted as "not allowed" will cause the claim line to deny. 00 -- Montana Healthcare Programs Mid-Level Fee Schedule Explanation Effective January 1, 2025 Definitions: RBRVS: Based on Medicare Relative Value Units (RVU’s) x Montana Medicaid Montana Healthcare Programs Fee Schedule Physician Services Effective July 1, 2024 Proc. 97 $12. Conversion factor for fiscal year 2022 is Montana Healthcare Programs Fee Schedule Optometric Services Proposed July 1, 2024 Proc Mod Mod Description Effective Method Office Fees Facility Fees Global V2627 - SCLERAL COVER SHELL 7/1/2021 MEDICARE $1,674. Revenue Code Description Fee . This tool is located in the Availity portal under Claims & Payments navigation menu. While public comment on MAR Notice 37-1067 remains open, the Department is on track to incorporate the July 1 Montana Healthcare Programs Fee Schedule Dental Services July 1, 2022 Proc Mod. Except as otherwise noted in the plan, state- developed fee schedule rates are the same for both governmental and private providers of physician, dental and podiatry services. Conversion factor for fiscal year 2024 is Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Medicaid fee; not determined using RBRVS payment schedule . Medicaid fee; not determined using RBRVS payment schedule . 93 $75. 00 - - - - - - - - - - G0008 - ADMIN INFLUENZA VIRUS VAC 7/1/2021 FEE SCHED $21. Laboratory services are paid at 62% of listed fee for sole community hospitals and at 60% for others. 00 -- - - - - - - - - - A4562- PESSARY, NON RUBBER,ANY TYPE 1/1/2023 Montana Medicaid - Fee Schedule Non-Emergency Specialized Transportation July 1, 2023 Proc Modifier Description Effective Method Fee PA Notes A0100 - NONEMERGENCY TRANSPORT PER MILE 7/1/2023 FEE SCHED $1. Box 4210 . Y: Prior authorization is required by this code . Summary: The Medicaid program provides health care coverage to over 300,000 low-income Montanans. Description: Montana Facility Fee Schedule Documents 2024 Fee Schedules - Effective 7/1/2024. Y Montana Medicaid fee for Physical Therapy, Occupational Therapy or Speech and Montana Healthcare Programs Fee Schedule Personal Assistance Services Proposed July 1, 2024 Proc Mod Mod Description Effective Method Fees PA A0080--Non-Emergency Transportation - per mile 7/1/2023: Fee Sched $0. Medicare: Medicare-prevailing fee for listed code. Bilat: Assist. Definitions: Medicaid fee; not determined using RBRVS payment schedule Medicare: Medicare-prevailing fee. Montana Medicaid adopts and incorporates by reference the Region D Supplier Manual, effective April 1, Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Medicaid fee; not determined using RBRVS payment schedule Payment to charge ratio: 90% of provider billed charges . 34 Y - A0382 - BASIC SUPPORT ROUTINE SUPPLS Fee Sched: Based on Relative Value for Dentists (RVD) Montana Medicaid Dental x Conversion Factor. State expenditures on Medicaid have remained Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services July 1, 2024 Proc Mod Description Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes: HELENA — A last-minute change to a 2019 bill put an end date on Montana’s Medicaid expansion program, setting the stage for what is anticipated to be the most Medicare does not recognize the new American Medical Association (AMA) CPT® codes (98000-98015) for E/M telehealth services. H2034 HD SUD Clinically Managed Low Intensity (ASAM 3. Conversion factor for fiscal year 20is 22 Method – Source of Fee Determination: Note: If a valid, current code is not present, that code may be a non-covered service Fee Sched: Medicaid fee; not determined using RBRVS payment schedule Medicare: Medicare-prevailing fee. Laboratory services are paid at 62% of listed fee for sole communityhospitals and at 60% for others. 36 $0. 96 - - Montana Medicaid - Fee Schedule Home Dialysis Proc Modifier Description Effective Method Fee Z0565 PERSONAL CARE - DIALYSIS (NURSE) 7/1/98 FEE SCHED $ 15. 00 5/1/2024 SUD Non-Medicaid Provider Fee Schedule Effective 7/1/2021 . P. Mult: Bilat. 56 $ 114. 42 $ 69. 20 $25. Conversion factor for fiscal year 202is 1 The Medicare home infusion therapy services benefit covers the professional services, including nursing services furnished with the plan of care, patient training, and education (not otherwise covered under the durable medical equipment benefit), remote monitoring and home infusion drugs. Attn: Mary Eve Kulawik . 73 H0045 UA Respite Care - Nursing Facility diem *Medicaid Adult Medicaid Mental Health Fee Schedule Effective 07/01/2023 Medicaid Mental Health Services . Proc Mod Description Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes:-----E0256 Home and Community Based Services – SDMI Waiver Fee Schedule Effective 7/1/2024. 72 Notes: Montana Medicaid uses the Outpatient Code Editor to group outpatient hospital claims. The agency’s fee schedule rate was set as of July 1, 2022 and is effective for services provided on or after that date. You must refer to the appropriate official CPT or HCPCS Fee Schedule adopted by the Centers for Medicare & Medicaid Services (CMS) of the U. Conversion factor for fiscal year 2020 is Montana Healthcare Programs Durable Medical Equipment Fee Schedule Explanation Effective January 1, 2022 . 24 $ 109. When the vaccine administration is provided during an all-inclusive rate (AIR) eligible encounter, the vaccine administration will be paid for New technology APCs and some other APCs with no Medicare assigned weights have been assigned weights for Montana Medicaid based on the Medicare allowed payment. Montana Department of Public Health & Human Services . Conversion factor for fiscal year 20is $22 35. The proper diagnosis code for the member being served can be obtained from the member’s physician. Proposed Effective July 1, 2021 . Hospital Lab Fees Min Age Max Age Comments; Montana Healthcare Programs Fee Schedule Physician Services Proposed Effective January 1, 2023 Proc Mod. Status Indicator J1 Complexity Reimbursement Correct Coding Initiative (CCI) Edits Home and Community Based Services – SDMI Waiver Fee Schedule Effective 7/1/2022. Services Not Reimbursed By Montana Medicaid •Community Health Representatives •Equine Therapy •Registered Nurse •Social Workers (Bachelor SW) 5. Title: Dialysis. 00 - - - - - - - - - A4562 Montana Healthcare Programs Fee Schedule Home Health Services July 1, 2023 Rev Description Effective Method Fee PA 421. Helena, MT 59604 . Policy Adjuster: MEDICARE $324. 33 - S5125 - Specially Trained Attendant: 7/1/2022 Fee Sched: $5. In order to assure correct coding. 00 $520. CoSurg: Team. 95 Y - 97167 UA Occupational Therapy - Eval High Complx 60 min Montana Healthcare Programs Mid-Level Fee Schedule Explanation . in Montana Medicaid as a crisis provider. 61 Y--- - - - - - Montana Healthcare Programs Personal Assistance Services Fee Schedule Explanation . 79 $12. Effective Method Fees PA; A0080 - Non-Emergency Transportation - per mile; 10/1/2008 Fee Sched $ 0. 79 H0045 UA Respite Care - Assisted Living diem $175. Acute care hospital services will be reimbursed for Medicaid members under the Montana Medicaid program’s Diagnosis Related Group (DRG Home and Community Based Services – SDMI Waiver Fee Schedule Effective 7/1/2024. Conversion factor for fiscal year 2025 is Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services January 1, 2024 Proc Cd 2024 APC Status Ind Proc Desc Proc Modifier APC APC Weight Method -Medicare $1,200. Box 4210 Helena, MT 59604 . 00 5/1/2024 Centers for Medicare & Medicaid Services . 00 - - Montana Healthcare Programs Fee Schedule Physician Services Proposed Effective July 1, 2024 Proc. Mod . 02 - - Y - - - - - - 92553 - AUDIOMETRY AIR & BONE 7/1/2020 RBRVS $26. 97598 - DBRDMT OPN WND ADDL 20CM/< 7/1/2024 RBRVS $36. B. 05 $0. Definitions: Modifier: When a modifier is present, this indicates system may have different reimbursement or code edits for that procedure code/modifier combination. Procedure Code Modifier Description Unit Rate Limits . mt. For example: U9 = self-directed . Website Postings by Week for 2024 • July Proposed Fee Schedules 2024 Non-Medicaid Mental Health Crisis Services Fee Schedule 5/22/2024 5/24/2024 07/01/2024 Montana Medicaid and Health Services Executive Director/State Medicaid Director Montana Department of Public Health and Human Services P. 00 $446. 74 $52. Montana Healthcare Programs Fee Schedule Psychiatrist Services Policy Adjust. 39 Notes: Montana Medicaid uses the Outpatient Code Editor to group outpatient hospital claims. published fee schedule amount. 99 $19. A4436 - IRR SUPPLY SLEEV REUS PER MO 1/1/2025 MEDICARE $26. 18 $503. Allied Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services Proposed July 1, 2024 Proc Cd 2024 APC Status Ind Proc Desc Proc Modifier APC -Medicare 414 257 249 - - 000 999 0024A; E FEE COVID-19 VAC 3 RES - - - Not Allowed 000 - - - - 000 999 0024U; Q GLYCA NUC MR SPECTRSC QUAN - - - Medicare 057 035 034 - - 000 999 Montana Healthcare Programs Physical Therapy Fee Schedule Explanation . 42 None H2034 SUD Clinically Managed Low Intensity (ASAM 3. 00: V2100: LENS SPHER SINGLE PLANO 4. 86 - S5126 U9 - Community Supports Services; Medicaid fee; not determined using RBRVS payment schedule . Fee . Proc Mod Description Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes:-----E0256 Medicaid fee; not determined using RBRVS payment schedule . The Department will reimburse providers based on these proposed fee schedules effective July 1, 2024. time increment units and multiplied by the anesthesia co nversion factor of . 83 - 000 999 - D0191 - ASSESSMENT OF A PATIENT 7/1/2023 FEE SCHED $18. 86 - Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc . 2024. All out-of-state admissions of Montana Medicaid 4. Montana Healthcare Programs Fee Schedule Mid-Level Services Effective January 1, 2025 Proc. 56 - 000 999 Members with Full Medicaid; 1 every 5 years Montana Healthcare Programs Speech Therapy Fee Schedule Explanation . The Department’s fee schedule rates were set as Montana Medicaid’s RBRVS-based fee schedule is based largely on the Medicare model, with a few differences as described below. 00 - - - - - - - - - - Montana Healthcare Programs Mid-Level Fee Schedule Explanation Effective January 1, 2025 Definitions: RBRVS: Based on Medicare Relative Value Units (RVU’s) x Montana Medicaid conversion factor x policy adjuster. 00: $0 SUD Medicaid Provider Fee Schedule Effective 10/1/2022 01/01/2023 Substance Use Disorder Medicaid Provider Fee Schedule Effective October 1, 2022 January 1, 2023 . 7/1/24 . Description Effective Method Fees PA Min Age Max age Notes--DIAGNOSTIC SERVICES --- - - -- D0120 - PERIODIC ORAL EVALUATION 000 999 Members with Full Medicaid; 1 every 5 years D2920 - DENTAL RECEMENT CROWN 7/1/2022 FEE SCHED $53. • Calendar Year (CY) 2025 Medicare Physician Fee Schedule Final Rule | CMS • MM13887 - Medicare Physician Fee Schedule Final Rule Summary: CY 2025 • Vaccine Pricing | CMS Montana Medicaid will pay either rental fees indefinitely for certain items or paying for items listed by Medicare as capped or classified as routine for a 13-month • July 2023 Medicaid Behavioral Health Targeted Case Management Fee Schedule • fee. Description: Effective Method Office Fees Facility Fees; Global Days PA; Pass: Mult. Effective January 1, 2023 . 32 $0. MSRP: Manufacturers Suggested Retail Price (MSRP): Equals a percentage of billed charges based on MSRP or the provider Home and Community Based Services – SDMI Waiver Fee Schedule Effective 7/1/2024. 51 H0045 UA HD Respite Care - Nursing Facility diem *Medicaid Montana Healthcare Programs Fee Schedule. 00 290 Durable Medical Equipment (DME) $719. 92552 - PURE TONE AUDIOMETRY AIR 7/1/2020 RBRVS $22. PA: Prior Authorization . Description Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist CoSurg Team Policy Adjust Comments; A4206 - 1 CC STERILE SYRINGE&NEEDLE : 7/1/2019: RBRVS $0. July 2024 Ambulance Coversheet July 2024 Ambulance Fee Schedule PDF July 2024 Ambulance Fee Schedule Excel January 2024 Ambulance Coversheet January 2024 Ambulance Fee Review and Process through Qualitrac Portal REISSUED 05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered 05/13/2022 Montana Healthcare Programs Mid-Level Fee Schedule Explanation . Montana Healthcare Programs Fee Schedule Physical Therapy Services Proposed January 1, 2024. Fee Sched: Medicaid fee; not determined using RBRVS payment schedule . 00 300 Montana Medicaid Fee Schedule Dialysis Clinics Proposed July 1, 2024 Revenue Code Description Fee 821 Hemodialysis/composite rate or other rate $281. MSRP: Manufacturers Suggested Retail Price (MSRP): Equals a percentage of billed charges based on MSRP or the provider acquisition cost (when no MSRP x Montana Medicaid conversion factor x policy adjuster. 00 - - 000 999 0002M; Q LIVER DIS 10 ASSAYS W/ASH--- Medicare $839. 00 Fee Schedule - Medicaid Mental Health Adults 18 and Over Bipartisan Budget Act of 2018 Cost Avoidance Statute Changes 05/16/2022 Help Members Receive Important Information from Montana Medicaid and Stay Covered 05/13/2022 Revalidation Extended REVISED 05/13/2022 National Drug Code Montana Healthcare Programs Fee Schedule Ambulance Services July 1, 2024 Proc Mod Description Effective Method Fees PA Pass A0021 - OUTSIDE STATE AMBULANCE SERV 7/1/2024 NEGOTIATED RATE $0. PDF Author: Unknown Created Date Montana Healthcare Programs School Based Health Fee Schedule Explanation Effective October 1, 2024 Definitions: Fee Sched: Medicaid fee; not determined using RBRVS payment schedule Medicare: Medicare-prevailing fee. Effective July 1, 2023 . Specific to Montana Medicaid, there is an ability to multiply the fee times a policy adjuster (either plus or minus) to affect the fee. Medicare: Medicare-prevailing fee. Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist Co Surg Team Policy Adj Comments; A9571 - INDIUM IN-111 AUTO PLATELET ; 1/1/2022 FEE SCHED : $4,076. Description: Effective. These codes are listed under the CY 2025 Prior Authorization is required on all services listed within the HCBS SDMI fee schedule excluding H0032 Case Management. 00 $744. 821 Hemodialysis/composite rate or other rate $283. 00 - 000: 999 - A4207 - 2 CC STERILE Montana Healthcare Programs Fee Schedule Public Health Services July 1, 2024 Proc Mod Description Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist CoSurg Team Policy Adj Notes A4266 - DIAPHRAGM 7/1/2024 FEE SCHED $53. Description- Procedure code short description. Montana Healthcare Programs APC Fee Schedule Explanation Created Date: 5/3/2023 1:47:09 PM *Physician Fee Schedules **Medicaid Nursing Facility Rates: Montana and Out of State Providers: N/A: Rev Code Description Daily Rate Hrly Rate Index Wage Component Subject to Index Non-Weighted: Wage Adjusted Rate Hospice Rate Hour 15 Min: 651: Routine Home Care 1-60 days $ 207. You must refer to the appropriate official CPT or HCPCS Fee-for-Service (FFS) Reimbursement • Fee-for-Service: Each mental health procedure code billed will be reimbursed under the appropriate billing provider type fee schedule. Practitioner Services Mental health practitioners include physicians, physician assistants, nurse practitioners, psychologists, social workers, and professional counselors. 28 Y < 16 Miles Medicaid fee; not determined using RBRVS payment schedule . Marie Matthews, State Medicaid Director . 00 - - - - - - - - D0120 - PERIODIC ORAL rule 37. applicable fee schedule rate. 15 Y - T1019 - PERSONAL CARE SER PER 15 MIN 7/1/2024 FEE SCHED $8. 11 - - 000 999 Medicaid fee; not determined using RBRVS payment schedule . Health The Iowa Medicaid Provider Fee Schedules are listed below. Montana Healthcare Programs Mid-Level Fee Schedule Explanation Proposed Effective January 1, 2025 Definitions: RBRVS: Based on Medicare Relative Value Units (RVU’s) x Montana Medicaid conversion factor x policy adjuster. 73 $179. Conversion factor for fiscal year 2024 is Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services January 1, 2023 Proc Mod Description. Adults with Severe Disabling Mental Illness (SDMI) Effective July 1, 2024 . Dialysis Clinics . 59 $0. For example: 26 = professional component . Montana Medicaid - Fee Schedule Home and Community Based Services (HCBS) for Adults with Severe Disabling Mental Illness (SDMI) Effective July 1, 2021 . Description: PROPOSED Medicaid Youth Mental Health Fee Schedule Page 1 of 4 January 1, 2021July 1, 2021 I. Hospital Lab Fees Non-sole Comm. 00 300 Montana Medicaid – Fee Schedule Eyeglasses May 1, 2024: Proc Modifier Description Effective Method Fee PA: V2020: VISION SVCS FRAMES PURCHASES : 5/1/2024 FEE SCHED : $14. • Behavioral health services administered for youth and adult mental health and substance use disorders (SUD) are reimbursed using Fee-for-Service. Home and Community Based Services (HCBS) for . 73 H0045 UA Respite Care - Nursing Facility diem *Medicaid Medicaid fee; not determined using RBRVS payment schedule . Effective July 1, 2024 . Method: Office Fees Facility Fees A4341 - IDUC VALVE PAT INST REPL 4/1/2023 MEDICARE $324. Montana Healthcare Programs Fee Schedule Mid-Level Services Effective January 1, 2023 Proc Mod. Montana Medicaid - Fee Schedule . 92 $13. Method: Office Fees Facility Fees Global 1/1/2024 MEDICARE ; Montana Healthcare Programs Fee Schedule Outpatient Prospective Payment System Services October 1, 2024 Proc Cd 2024 APC Status Ind Proc Desc Proc Modifier APC APC Weight Medicare Outpatient Code Editor (OCE), and a Montana Medicaid OPPS conversion factor to price outpatient PPS hospital claims. 29 $0. Acute care hospital services will be reimbursed for Medicaid members under the Montana Medicaid program’s Diagnosis Related Group (DRG) reimbursement system. 93 $0. Skip to main content Official State of Iowa Website. Community NH of Anaconda Anaconda $286. 00 - - - - - - Montana Healthcare Programs Fee Schedule Dental Hygienist Services Proposed July 1, 2023 Proc Mod Description Effective Method Fees PA Min Age Max age Notes D0190 - SCREENING OF A PATIENT 7/1/2023 FEE SCHED $25. The department is requesting additional Montana Healthcare Programs Physician Fee Schedule Explanation . 02 Y Montana Medicaid - Fee Schedule -Home and Community Based Services SDMI Waiver- Proc Mod Description Unit Fee H0032 HD Case Management day $13. 02 851 Continuous Cycling Peritoneal Dialysis (CCPD)/ Montana Medicaid Fee Schedule . Definitions: Modifier: Medicaid fee; not determined using RBRVS payment schedule . Page 2. Outpatient Hospital Fee Schedule Sole Comm. 86 ZZZ - Y - - - - - - 97602 - WOUND(S) CARE NON-SELECTIVE 7/1/2019 RBRVS Montana Healthcare Programs Fee Schedule Community First Choice Services July 1, 2022 Proc Mod Description. 57 $ 185. Conversion factor for fiscal year 2025 is $43. 47 None H0048 Dip Strip or Saliva Collection, Handling, Montana Medicaid - Fee Schedule Children's Chiropractic July 1, 2023 Proc Mod Description Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist CoSurg Team Policy Adjuster 72040-X-RAY EXAM OF NECK SPINE : 7/1/2023 RBRVS : $52. 00 $0. 00 000 999 - 0002A M ADM SARSCOV2 30MCG/0. 66 N/A 0. This proposed fee schedule will be updated with new and deleted CPT/HCPCS codes and rates published in the Calendar Year 2022 Medicare Physician, Durable Medical Equipment, CLAB, and ASP fee schedules. Definitions: Effective January 1, 2024 . 18 $312. 13 1/1/2024 MEDICARE ; 999 - 1/1/2024 MEDICARE ; N 000; 999 - Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services January 1, 2024. 97 $177. 85 $0. U9 Montana Healthcare Programs APC Fee Schedule Explanation Effective April 1, 2024 Definitions: Conversion Factor: Montana Medicaid Conversion Factor $58. $32. 54 $26. 50; $0. 51-S5126 - - Community Supports Services 7/1/2024 Fee Sched. 04 . 105 - effective dates, conversion factors, policy adjusters, and cost-to-charge ratios of montana medicaid provider fee schedules; rule 37. 00 - - - - - - - - - - A4267 - MALE CONDOM Fee Schedules; Instructions if Having Trouble Accessing the Open Fee Schedule; Fee Schedule Agreement. $8. All out-of-state admissions of Medicaid members require prior authorization Montana Healthcare Programs Laboratory Services Fee Schedule Explanation . The OCE is a program that provides claims editing, APC In a survey of 27 Montana critical access hospitals, 93% reported adding or expanding new specialty services since 2016. Developmental Disabilities Program: MMIS Billing Code: Primary Modifier . 79 $0. RBRVS: Based on Medicare Relative Value Units (RVU’s) x Montana Medicaid Montana Medicaid Fee Schedule Dialysis Clinics July 1, 2023 Revenue Code Description Fee 821 Hemodialysis/composite rate or other rate $271. 51 H0045 UA HD Respite Home and Community Based Services – SDMI Waiver Fee Schedule Effective 7/1/2021. 51 H0045 HD Respite Care - Nursing Facility diem *Medicaid H2015 HD Consultative Clinical and Therapeutic Services service $388. 75 $19. 96 . 45 - 000 999 -. 65 $0. Montana Healthcare Programs Fee Schedule Occupational Therapy Services January 1, 2022 Proc Mod. MSRP: Manufacturers Suggested Retail Medicaid fee; not determined using RBRVS payment schedule . Definitions: Description . Anes Value: Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services July 1, 2023 Proc Mod Description Effective Method Non Rural Fee Rural Fee PA Min Age Max Age Notes: 10 ML 1/1/2023 MEDICARE $0. 43-S5126. Physical Therapy - Vist Charge: 7/1/2023: FEE SCHED $ 82. 01/06/2025 Montana Prescription Drug Registry Survey for Federal Fiscal Year 2024. 104 - effective dates of provider fee schedules for montana non-medicaid services; rule 37. 1) (Women/children room & board) per day $140. 86 ZZZ - Y - - - - - - 97602-WOUND(S) CARE NON-SELECTIVE Montana Healthcare Programs Fee Schedule Psychiatrist Services January 1, 2021 Proc. 8147 $ 134. Acute Inpatient Services. 48 $0. 51 $ 178. gov/26 Montana Medicaid – Fee Schedule -Home and Community Based Services – SDMI Waiver Proc Primary Modifier Secondary Modifier Montana Medicaid and Health Services Executive Director/State Medicaid Director . time increment units and multiplied 1/1/2024 MEDICARE ; 999 - 1/1/2024 MEDICARE ; N 000; 999 - Montana Healthcare Programs Fee Schedule Durable Medical Equipment Services January 1, 2024. 05 H0045 UA HD Respite Care - Assisted Living diem $177. 16 Y: 431 Occupational Therapy - Visit Charge; 7/1/2023 FEE SCHED $ 82. Mod. 98 $ 70. Unit . Description Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist CoSurg Team Policy Adjust; 96125-OGNITIVE TEST BY HC PRO ; C 7/1/2021 RBRVS : $75. Montana Healthcare Programs Fee Schedule Audiology Services Effective January 1, 2021. , Suite 600 . Hospital Inpatient MS-DRG Reimbursement Hospital Outpatient and ASC Fee Schedule Modifiers Status Indicator Codes Status Indicator J1 Code Ranking. Nursing Facility . 05 ZZZ - Y - - - - - - 97602 - WOUND(S) CARE NON A complete list of Montana Medicaid procedure codes for ambulance services is available on the ambulance fee schedule which may download from the Ambulance page of the Provider Information website. Effective July 1, 2021 . Proc Mod Description Effective Method Office Fees Facility Fees Global Days PA Pass Mult Bilat Assist CoSurg Team Policy Adjust. A4561 - PESSARY RUBBER, ANY TYPE 1/1/2021 MEDICARE $24. 02 Y S5150 SC Respite - (both self direct options) 7/1/2024 FEE SCHED 15 minutes $ 6. 00 - - - - - - - - V2628 - FABRICATION & FITTING 7/1/2021 MEDICARE $405. 06 . 54: 0. Montana Healthcare Programs Fee Schedule Physical Therapy Services July 1, 2024. Modifier: Sched: Medicaid fee; not determined using RBRVS payment schedule Medicare: Medicare-prevailing fee. 16 Y 441; Speech Therapy - Visit Charge 7/1/2023 Montana Healthcare Programs Occupational Therapy Fee Schedule Explanation . H2011 U1 American Rescue Plan Act (ARPA) Mobile The Availity Fee Schedule viewer tool allows professional providers participating with BCBSMT to electronically request a range of up to 20 procedure codes and immediately receive the contracted price allowance for the patient services you perform. Definitions: Modifier: When a modifier is present, this indicates the system may have different reimbursement or code edits for that procedure code/modifier combination. Facility Fee Schedule Instructions. zteui wchjnf pvhkm hmhorc zdxcv yfkyci hlisg shoya fftxy hhtbvu