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Rule: 37.86.3025 Prev     Up     Next    
Rule Title: OUTPATIENT HOSPITAL SERVICES, REIMBURSEMENT FOR SERVICES NOT PAID UNDER THE AMBULATORY PAYMENT CLASSIFICATION SYSTEM
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Department: PUBLIC HEALTH AND HUMAN SERVICES
Chapter: MEDICAID PRIMARY CARE SERVICES
Subchapter: Outpatient Hospital Services
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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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.

(a) If the recipient is under 19 years old and vaccine is available to providers for free under the Vaccines For Children program, then the payment to the hospital is zero.

(b) Immunization administration is considered an incidental service and will be bundled with other APCs on the claim and paid at zero.

(4) Professional services, except as in ARM 37.86.3031 and 37.86.3037, 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.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.


 

 
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