Mont. Admin. R. 37.86.705 - AUDIOLOGY SERVICES, REIMBURSEMENT
(1)
Providers must bill for services using the procedure codes and modifiers set
forth, and according to the definitions contained in the Health Care Financing
Administration's Common Procedure Coding System (HCPCS). Information regarding
billing codes, modifiers, and HCPCS is available upon request from the
Department of Public Health and Human Services, Health Resources Division, 1401
East Lockey, P.O. Box 202951, Helena, MT 59620-2951.
(2) Subject to the requirements of this rule,
the Montana Medicaid program pays the following for audiology services:
(a) For patients who are eligible for
Medicaid, the lowest of:
(i) the provider's
usual and customary charge for the service;
(ii) the reimbursement provided in accordance
with the methodologies described in ARM
37.85.212;
(iii) 100% of the Medicare Region D allowable
fee; or
(iv) for items or services
where no RBRVS fee is available, the fee schedule amount will be calculated
using the following methodology:
(A)
Establishing a fee for a service or item that has been billed at least 50 times
by all providers in the aggregate during the previous 12-month period. The
department will set each fee at the payment-to-charge ratio under ARM
37.85.105(2)(d).
(B) For services where utilization cannot
meet the methodology outlined in (A), the fee shall be set at the same rate as
a service similar in scope.
Notes
AUTH: 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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