Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.30 - Outpatient Hospital Services
Rule 37.86.3009 - OUTPATIENT HOSPITAL SERVICES, PAYMENT METHODOLOGY, EMERGENCY VISIT SERVICES
Universal Citation: MT Admin Rules 37.86.3009
Current through Register Vol. 6, March 22, 2024
(1) For emergency visits that are not provided by exempt hospitals or critical access hospitals as defined in ARM 37.86.2901, reimbursement will be based on the ambulatory payment classifications APC methodology in ARM 37.86.3020, except emergency room visits with CPT codes 99281 and 99282 will be reimbursed based on the clinical APC weight.
(a) Passport to Health provider
authorization is not required for emergency room visits.
(2) Physician services are separately billable according to the applicable rules governing billing for physician services.
53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA;
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