(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) The department adopts and incorporates by reference the Physician-Related Services Manual governing the administration of the Physician program dated July 2014. The Physician-Related Services Manual is available for public viewing at the Department of Public Health and Human Services, Health Resources Division, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951 and at the department's web site at http://medicaidprovider.mt.gov.

(6) A "primary care service" for purposes of this rule means covered evaluation and management (E&M) procedure codes in the range 99201-99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473, and 90474 and their successors.

(7) A "primary care physician" for purposes of this rule means a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine and all subspecialties of these three specialties recognized by the American Board of Medical Specialties, American Board of Physician Specialties, and American Osteopathic Association.

(8) 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).