(1) Medicaid substance use disorder programs must bill for services using procedure codes, modifiers, and definitions contained in the:

(a) Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Code System (HCPCS); and

(b) American Medical Association's (AMA) Current Procedural Terminology (CPT) Codes.

(2) Subject to requirements of this rule, the Medicaid substance use disorder program pays the lower of the following for Medicaid eligible members:

(a) the Medicaid substance use disorder program's usual and customary charge for services;

(b) the reimbursement methodologies described in ARM 37.85.212; or

(c) for items or services where no Resource Based Relative Value (RBRVS) or Medicare fee is available, the department's fee schedule.

(3) The allowable Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.105.

(4) The allowable non-Medicaid substance use disorder procedure billing codes and department fee schedules are available at the department's website located at http://medicaidprovider.mt.gov/ and incorporated by reference at ARM 37.85.104.

(5) The allowable Medicaid substance use disorder reimbursement rate for case management services for members with substance use disorder is stated in the department's fee schedule provided in ARM 37.85.106.