Mont. Admin. r. 37.86.101 - PHYSICIAN SERVICES, DEFINITIONS
(1) "Early elective
delivery" means either a nonmedically necessary labor induction or cesarean
section that is performed prior to 39 weeks and 0/7 days gestation.
(2) "Physician services" means those services
provided by individuals licensed under the State Medical Practice Act to
practice medicine or osteopathy which, as defined by state law, are within the
scope of their practice.
(3)
"Usual and customary" means those charges that the billing physician would
charge for a particular service in a majority of cases, including Medicaid and
non-Medicaid patients.
(4) The
department hereby adopts and incorporates by reference the definitions found in
the introduction to Physicians Current Procedural Terminology, fourth edition
(CPT4), published by the American Medical Association of Chicago, Illinois.
These materials set forth meanings of terms commonly used by the Montana
Medicaid program in implementation of the program's physician fee schedule. A
copy of the definitions herein incorporated 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.
(5) Payment-to-charge ratio means the percent
determined by dividing the previous state fiscal year's total Medicaid
reimbursement for RBRVS provider covered services as defined in ARM
37.85.212 by the previous state
fiscal year's total Medicaid charges for RBRVS provider covered services. The
effective date and payment-to-charge ratio are as provided in ARM
37.85.105(2).
Notes
AUTH: 53-6-113, MCA; IMP: 53-6-101, 53-6-113, MCA
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