37.86.3016 OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, IMAGING SERVICES
(1) Imaging services will be reimbursed with the exception of hospitals reimbursed under ARM 37.86.3005(3) as follows:
(a) For each imaging service or procedure, the fee will be the APC rate as in ARM 37.86.3020 or Medicare fee if no APC rate exists. The imaging services reimbursed under this subsection are the individual imaging service codes defined in the CPT/HCPCS.
(b) For imaging services where no APC rate or Medicare fee has been assigned, a Medicaid fee will be set in accordance with the resource based relative value scale (RBRVS) methodology found at ARM 37.85.212.
(c) For imaging services where no APC rate, Medicare fee, or Medicaid fee has been assigned, outpatient hospital-specific percent of charges will be paid. Birthing centers and out-of-state hospitals will be reimbursed the statewide outpatient cost-to-charge ratio.
History: 53-2-201, 53-6-113, MCA; IMP, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2001 MAR p. 27, Eff. 1/12/01; AMD, 2001 MAR p. 1119, Eff. 6/22/01; AMD, 2002 MAR p. 1991, Eff. 8/1/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2012 MAR p. 1382, Eff. 7/13/12.