(1) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the Health Care Financing Administration's Common Procedure Coding System (HCPCS). Information regarding billing codes, modifiers, and HCPCS is available upon request from the Department of Public Health and Human Services, Health Resources Division, 1401 East Lockey, P.O. Box 202951, Helena, MT 59620-2951.

(2) Subject to the requirements of this rule, the Montana Medicaid program pays the following for audiology services:

(a) For patients who are eligible for Medicaid, the lowest of:

(i) the provider's usual and customary charge for the service;

(ii) the reimbursement provided in accordance with the methodologies described in ARM 37.85.212; or

(iii) 100% of the Medicare Region D allowable fee.