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 37.86.3016 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES
Universal Citation: MT Admin Rules 37.86.3016
Current through Register Vol. 18, September 20, 2024
(1) Imaging services will be reimbursed with the exception of hospitals reimbursed under ARM 37.86.3005(3) as follows:
(a) For each imaging service or
procedure, the fee will be the APC rate as in ARM
37.86.3020 or Medicare fee if no
APC rate exists. The imaging services reimbursed under this subsection are the
individual imaging service codes defined in the CPT/HCPCS.
(b) For imaging services where no APC rate or
Medicare fee has been assigned, a Medicaid fee will be set in accordance with
the resource based relative value scale (RBRVS) methodology found at ARM
37.85.212.
(c) For imaging services where no APC rate,
Medicare fee, or Medicaid fee has been assigned, outpatient hospital-specific
percent of charges will be paid. Birthing centers and out-of-state hospitals
will be reimbursed the statewide outpatient cost-to-charge ratio.
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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