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(1) Providers must bill for covered services using the procedure codes and modifiers set forth and according to the definitions contained in the CMS's Healthcare 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, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for licensed psychologist services:

(a) For patients who are eligible for Medicaid, the lower of:

(i) the provider's usual and customary charge for the service; or

(ii) the amount specified in the department's Medicaid Mental Health Fee Schedule.

(3) Reimbursement and claim completion instructions for Medicaid designated provider based entities are found in ARM 37.86.3031 and 37.86.3037.

History: 53-2-201, 53-6-113, 53-21-703, MCA; IMP, 53-1-601, 53-1-602, 53-1-603, 53-6-101, 53-6-113, 53-21-202, 53-21-701, 53-21-702, MCA; NEW, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 195; AMD, 2001 MAR p. 1476, Eff. 8/10/01; AMD, 2001 MAR p. 2156, Eff. 10/26/01; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2008 MAR p. 1988, Eff. 9/12/08.

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