Mont. Admin. R. 37.86.3016 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES
(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.
Notes
53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA;
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.