Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.32 - Nonhospital Laboratory and Radiology (X-Ray) Services
Rule 37.86.3205 - NONHOSPITAL LABORATORY AND RADIOLOGY (X-RAY) SERVICES, REIMBURSEMENT
Universal Citation: MT Admin Rules 37.86.3205
Current through Register Vol. 18, September 20, 2024
(1) These reimbursement requirements are in addition to those contained in ARM 37.85.212 and 37.86.105.
(2) Independent laboratory providers must meet the following requirements to receive Medicaid reimbursement:
(a) the independent laboratory
provider must be certified by Medicare;
(b) the independent laboratory provider must
meet any state licensing requirements for laboratory facilities; and
(c) the independent laboratory service must
have been ordered by a physician, dentist, or other practitioner licensed to
practice in Montana.
(i) Medicaid does not
reimburse services ordered by chiropractors.
(3) Independent radiology (x-ray) services must meet the following requirements to receive Medicaid reimbursement:
(a) the independent radiology provider must
meet any state licensing requirements for radiology facilities;
(b) the independent radiology service must be
ordered by a physician, dentist, or other practitioner licensed within the
scope of his practice as defined by state law;
(c) technical components of diagnostic and
therapeutic radiology services must be performed by an appropriately licensed
provider within the scope of his practice as defined by state law and under the
supervision of a physician; and
(d) the physician with supervisory
responsibilities for the radiology services must meet state licensing
requirements; and
(e) technical
components of the radiology (x-ray) service must be billed by and reimbursed to
the supervising physician.
(4) For clinical laboratory services, the department pays the lower of:
(a) the
provider's usual and customary charges for the service;
(b) 60% of the Medicare fee schedule for
physician offices and independent labs and hospitals functioning as independent
labs; or
(c) the Medicaid fee as
determined at ARM
37.86.105(7)
if there is no fee determined at (4)(b).
AUTH: 53-6-113, MCA; IMP: 53-6-113, MCA
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