37.86.1001    DENTAL SERVICES, DEFINITIONS

For purposes of this subchapter, the following definitions apply:

(1) "By-report method" means the department reimburses a percent of the provider's usual and customary charges for a procedure code for which no fee has been assigned.

(2) "Conversion factor" means the multiplier used to convert the relative value unit or units of a procedure to a reimbursement rate a provider may receive in payment from Montana Medicaid. The dental conversion factor approximates the amount the Legislature has appropriated for one unit of value of dental services.

(3) "Dental service" means medically necessary treatment of the teeth and associated structures of the oral cavity. Dental service includes the provision of orthodontia and prostheses.

(4) "Dental hygiene" means services performed by a licensed preventive oral health practitioner known as a dental hygienist, that are therapeutic, prophylactic, or preventive procedures in nature.

(5) "Dental hygienist" means a licensed preventive oral health practitioner practicing in compliance with the provisions of Title 37, chapter 4, MCA.

(6) "Policy adjustor" means a factor by which the product of the relative value units of a procedure or the conversion factor is multiplied to increase or decrease the fees paid by Montana Medicaid for certain categories of services.

(7) "Procedure code" means the number identifying a particular procedure. Montana Medicaid has adopted national uniform procedure codes.

(8) "Public health supervision" means the provision of limited dental hygiene preventative services without the prior authorization or presence of a licensed dentist in a public health facility.

(9) "Relative Values for Dentists (RVD) Scale" means the scale published biennially by Relative Value Studies Inc., 1675 Larimer, Suite 410, Denver, CO 80202, listing the relative value of dental services provided by dentists and denturists.

(10) "Relative value unit (RVU)" means a numerical value assigned in the resource based relative value scale to each procedure code for which a relative value is available. The RVD is a comprehensive relative value system that lists dental procedures used by dentists, denturists, and hygienists as an expression of the relative effort and expense expended by a provider in providing one service as compared to another service.

History: 53-6-113, MCA; IMP, 53-6-101, MCA; NEW, 1980 MAR p. 1747, Eff. 6/27/80; AMD, 1985 MAR p. 1410, Eff. 9/27/85; AMD, 1999 MAR p. 1522, Eff. 7/2/99; TRANS, from SRS, 2000 MAR p. 481; AMD, 2001 MAR p. 1117, Eff. 6/22/01; AMD, 2006 MAR p. 1894, Eff. 7/28/06; AMD, 2007 MAR p. 1824, Eff. 11/9/07; AMD, 2009 MAR p. 1017, Eff. 7/1/09.