Admin. R. Mont. 37.86.1005 – Dental Services, Reimbursement

(1) For dental services listed in the department's fee schedule, the department will pay the lowest of the following for dental services covered by the Medicaid program:
1. (a) the provider's usual and customary charge for the service;
2. (b) the amount determined using the methodology described in ARM 37.86.1004; or
3. (c) for items or services when there is no RVD, the department will set the fee at the same rate as a service similar in scope.
(2) No extra fee for pulp capping or bases is reimbursable.
(3) Payment for all dentures includes:
1. (a) payment for any tissue conditioners provided;
2. (b) the first three adjustments after the dentures are placed; and
3. (c) adjustments during the first year after delivery of the dentures is available only to a dentist or denturist who did not make the dentures.
(4) Medical procedures, within the scope of practice for licensed dentists, that are not listed in the dental services provider manual are reimbursed in accordance with the methodologies provided in ARM 37.85.212 and 37.86.105.
(5) A dentist examining more than one Medicaid recipient in a long term care facility on the same day is allowed payment for one nursing home call in addition to the examination fees. Examination is considered a recorded evaluation.

Authorizing statute(s): 53-2-201, 53-6-113, MCA

Implementing statute(s): 53-6-101, 53-6-113, MCA

History: NEW, 1980 MAR p. 1752, Eff. 6/27/80; AMD, 1981 MAR p. 559, Eff. 6/12/81; AMD, 1981 MAR p. 1975, Eff. 1/1/82; AMD, 1982 MAR p. 301, Eff. 2/12/82; AMD, 1982 MAR p. 1289, Eff. 7/1/82; AMD, 1985 MAR p. 1410, Eff. 9/27/85; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1988 MAR p. 286, Eff. 3/1/88; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1988 MAR p. 1995, Eff. 9/9/88; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1990 MAR p. 1331, Eff. 7/13/90; AMD, 1990 MAR p. 1479, Eff. 7/27/90; AMD, 1993 MAR p. 2433, Eff. 10/15/93; AMD, 1995 MAR p. 1968, Eff. 10/1/95; AMD, 1999 MAR p. 1522, Eff. 7/2/99; AMD, 1999 MAR p. 2898, Eff. 12/17/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2000 MAR p. 1664, Eff. 6/30/00; AMD, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 1017, Eff. 7/1/09; AMD, 2010 MAR p. 2986, Eff. 1/1/11; AMD, 2014 MAR p. 2474, Eff. 7/1/14; AMD, 2017 MAR p. 134, Eff. 1/21/17.