Administrative Rules of Montana › Department 37 - PUBLIC HEALTH AND HUMAN SERVICES › Chapter 37.85 - GENERAL MEDICAID SERVICES › Subchapter 37.85.1 - Montana Medicaid Provider Fee Schedules › Rule 37.85.105 - EFFECTIVE DATES, CONVERSION FACTORS, POLICY ADJUSTERS, AND COST-TO-CHARGE RATIOS OF MONTANA MEDICAID PROVIDER FEE SCHEDULES

Current through Register Vol. 13, July 5, 2024
(1) The Montana Medicaid Program establishes
				provider reimbursement rates for medically necessary, covered services based on
				the estimated demand for services and the legislative appropriation and federal
				matching funds. Provider reimbursement rates are stated in fee schedules for
				covered services applicable to the identified Medicaid program. New rates are
				established by revising the identified program's fee schedule and adopting the
				new fees as of the stated effective date of the schedule. Copies of the
				department's current fee schedules are posted at
http://medicaidprovider.mt.gov
. A
				description of the method for setting the reimbursement rate and the
				administrative rules applicable to the covered service are published in the
				chapter or subchapter of this title regarding that service. The department will
				make periodic updates, as necessary, to the fee schedules noted in this rule to
				include new procedure codes and applicable rates and to remove terminated
				procedure codes.
(2) The department
				adopts and incorporates by reference, the resource-based relative value scale
				(RBRVS) reimbursement methodology for specific providers as described in ARM
				37.85.212 on the date stated.
(a) Resource-based relative value scale
				(RBRVS) means the version of the Medicare resource-based relative value scale
				contained in the Medicare Physician Fee Schedule adopted by the Centers for
				Medicare & Medicaid Services (CMS) of the U.S. Department of Health and
				Human Services and published at 87 Federal Register 69404 (Nov. 18, 2022),
				effective January 1, 2023, which is adopted and incorporated by reference.
				Procedure codes created after January 1, 2023, will be reimbursed using the
				relative value units from the Medicare Physician Fee Schedule in place at the
				time the procedure code is created.
(b) Fee schedules are effective July 1, 2023.
				The conversion factor for physician services is $44.32. The conversion factor
				for allied services is $26.13. The conversion factor for mental health services
				is $22.67. The conversion factor for anesthesia services is $32.04.
(c) Policy adjustors are effective July 1,
				2023. The maternity policy adjustor is 100%. The family planning policy
				adjustor is 105%. The psychological testing policy adjustor is 200%. The
				psychological testing policy adjustor applies only to psychologists.
(d) The BCBA/BCBA-D services policy adjuster
				is 115.8%, effective July 1, 2021.
(e) The payment-to-charge ratio is effective
				July 1, 2023, and is 46.8% of the provider's usual and customary
				charges.
(f) The specific
				percentages for modifiers adopted by the department are effective July 1,
				2016.
(g) Psychiatrists receive a
				112% provider rate of reimbursement adjustment to the reimbursement of
				physicians effective July 1, 2016.
(h) Midlevel practitioners receive a 90%
				provider rate of reimbursement adjustment to the reimbursement of physicians
				for those services described in ARM
				37.86.205(5)(b),
				effective July 1, 2016.
(i)
				Optometric services receive a 115.50% provider rate of reimbursement adjustment
				to the reimbursement for allied services, as provided in ARM
				37.85.105(2),
				effective July 1, 2023.
(j)
				Reimbursement for physician-administered drugs described in ARM
				37.86.105 is determined pursuant
				to 42 U.S.C.
				1395w-3a.
(k) Reimbursement for vaccines described at
				ARM 37.86.105 is effective July 1,
				2020.