Mont. Admin. R. 37.27.905 - MEDICAID SUBSTANCE USE DISORDER SERVICES: REIMBURSEMENT
(1) Medicaid substance use disorder programs
must bill for services using procedure codes, modifiers, and definitions
contained in the:
(a) Centers for Medicare
and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS);
and
(b) American Medical
Association's (AMA) Current Procedural Terminology (CPT) Codes.
(2) Subject to requirements of
this rule, the Medicaid substance use disorder program pays the lower of the
following for Medicaid eligible members:
(a)
the Medicaid substance use disorder program's usual and customary charge for
services;
(b) the reimbursement
methodologies described in ARM
37.85.212;
or
(c) for items or services where
no Resource Based Relative Value (RBRVS) or Medicare fee is available, the
department's fee schedule.
(3) The allowable Medicaid substance use
disorder procedure billing codes and department fee schedules are available at
the department's website located at
http://medicaidprovider.mt.gov/
and incorporated by reference at ARM
37.85.105.
(4) The allowable non-Medicaid substance use
disorder procedure billing codes and department fee schedules are available at
the department's website located at
http://medicaidprovider.mt.gov/
and incorporated by reference at ARM
37.85.104.
(5) The allowable Medicaid substance use
disorder reimbursement rate for case management services for members with
substance use disorder is stated in the department's fee schedule provided in
ARM
37.85.106.
Notes
AUTH: 53-6-113, 53-24-204, 53-24-208, 53-24-209, MCA; IMP: 53-6-101, 53-24-204, 53-24-208, 53-24-209, MCA
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