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 37.86.3025 - OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT FOR SERVICES NOT PAID UNDER THE AMBULATORY PAYMENT CLASSIFICATION SYSTEM

(1) Therapy services will be paid the facility fee in accordance with the RBRVS methodologies in ARM 37.85.212 using the allied services conversion factor. Therapy services include physical therapy, occupational therapy, and speech-language pathology and are subject to requirements and restrictions as in ARM 37.86.606.

(2) Dental services not grouping to an ambulatory payment classification (APC) will be reimbursed as specified in the department's outpatient fee schedule.

(3) Immunizations not grouping to an APC will be paid the same reimbursement provided in accordance with the RBRVS methodologies in ARM 37.85.212.

(4) Professional services must bill separately on a professional billing form according to applicable rules governing billing for professional services.

(5) Interim payment for certified registered nurse anesthetists (CRNAs) will be reimbursed at hospital specific outpatient cost to charge ratio and settled as a pass through in the cost settlement, as provided in ARM 37.86.2924.

(6) The department adopts and incorporates by reference the Outpatient Hospital Fee Schedule which is updated each quarter and is posted on the Medicaid web site. A written copy may be obtained through the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.