(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) 62% of the reimbursement provided in accordance with the methodologies described in ARM 37.85.212.
(3) Reimbursement and claim completion instructions for Medicaid designated provider based entities are found in ARM 37.86.3031 and 37.86.3037.