Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.10 - Dental Services
Rule 37.86.1004 - REIMBURSEMENT METHODOLOGY FOR RESOURCE BASED RELATIVE VALUE FOR DENTISTS (RVD)
Universal Citation: MT Admin Rules 37.86.1004
Current through Register Vol. 18, September 20, 2024
(1) For procedures listed in the relative values for dentists scale, reimbursement rates shall be determined using the following methodology:
(a) The fee for a covered service shall be
the amount determined by multiplying the relative value unit specified in the
relative values for dentists scale by the conversion factor specified in
(1)(c). The department adopts and incorporates by reference the Relative Values
for Dentists (RVDs) as provided in ARM
37.85.105(3).
(b) The conversion factor and provider fees
for dentists, dental hygienists, and denturists procedures are calculated as
follows:
(i) The total units of each
procedure code paid in a prior period is multiplied by the RVU as published in
(1)(a) to equal the RVD for each procedure code. Typically, the prior period
used is the prior state fiscal year.
(ii) The sum of all RVDs calculated in
(1)(b)(i) equals the total units of dental service.
(iii) The Montana Legislature's appropriation
for dental service during the appropriation period is divided by the total
units of dental service calculated in (1)(b)(ii). The resulting dollar value is
equal to one unit of dental value and is the dental conversion
factor.
(iv) The RVU as published
in (1)(a) for each dental procedure is multiplied by the dental conversion
factor calculated in (1)(b)(iii) to calculate the Medicaid reimbursement for
the procedure. When this calculation is made for all covered procedures the
Montana Medicaid Dental, Dental Hygienist, and Denturist Fee Schedules are
generated.
(v) A policy adjuster
may be applied to some fees calculated in (1)(b)(iv) for certain categories of
services or to the conversion factor to increase or decrease the fees paid by
Medicaid.
(c) The
conversion factor used to determine the Medicaid payment amount for services
provided to eligible individuals is provided in ARM
37.85.105(3).
53-2-201, 53-6-113, MCA; IMP, 53-6-101, MCA;
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