37.86.3009    OUTPATIENT HOSPITAL SERVICES, PAYMENT METHODOLOGY, EMERGENCY VISIT SERVICES

(1) For emergency visits that are not provided by exempt hospitals or critical access hospitals as defined in ARM 37.86.2901, reimbursement will be based on the ambulatory payment classifications APC methodology in ARM 37.86.3020, except emergency room visits with CPT codes 99281 and 99282 will be reimbursed based on the clinical APC weight.

(a) Passport to Health provider authorization is not required for emergency room visits.

(2) Physician services are separately billable according to the applicable rules governing billing for physician services.

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; EMERG, AMD, 2002 MAR p. 2665, Eff. 9/27/02; AMD, 2003 MAR p. 1652, Eff. 8/1/03; AMD, 2004 MAR p. 482, Eff. 2/27/04; AMD, 2005 MAR p. 265, Eff. 2/11/05; AMD, 2006 MAR p. 3078, Eff. 1/1/07; AMD, 2014 MAR p. 1415, Eff. 7/1/14.