Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.22 - Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT)
Rule 37.86.2207 - EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT (EPSDT) SERVICES, REIMBURSEMENT

(1) Reimbursement for an EPSDT service, except as otherwise provided in this rule, is the lowest of the following:

(2) Reimbursement for nutrition, private duty nursing services, and orientation and mobility specialist services are specified in the department's fee schedule. The department adopts and incorporates by reference the department's Private Duty Nursing Services EPSDT Fee Schedule, the Nutrition EPSDT Fee Schedule, and the Orientation and Mobility Specialist EPSDT Fee Schedule as provided in ARM 37.85.105(3). Reimbursement for outpatient chemical dependency treatment is outlined in ARM 37.27.912.

(3) A service for which a fee is not set in or determinable through the EPSDT provider manual, ARM 37.85.212 or 37.86.105 is reimbursed at a fee negotiated in advance of the provision of the service. A service provided before there is a negotiated fee is reimbursed at an amount determined by the department.

(4) Reimbursements for school-based health related services are specified in the School-Based Health Service Fee Schedule. Rates are adjusted to reimburse these services at the federal medical assistance percentage (FMAP) rate.