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 37.86.3018 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, OTHER DIAGNOSTIC SERVICES
Universal Citation: MT Admin Rules 37.86.3018
Current through Register Vol. 6, March 22, 2024
(1) Other diagnostic services will be reimbursed as follows with the exception of hospitals reimbursed under ARM 37.86.3005(4):
(a) the fee will be the APC rate as in ARM
37.86.3020 or the Medicare fee for
the same service if no APC rate exists. The individual diagnostic services
reimbursed under this subsection are those defined in the CPT/HCPCS;
(b) for other diagnostic services without an
APC rate or Medicare fee, a Medicaid fee will be assigned in accordance with
the RBRVS methodology in ARM
37.85.212; or
(c) for other diagnostic 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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