Montana Medicaid reimbursement rates for 2027 are not one flat price for the whole state. The amount a claim pays depends on who the provider is, what service was done, and how Montana pays for that service. The date of service, modifiers, place of service, and coverage rules also play a part.
The official source is Montana Healthcare Programs. The Montana Department of Public Health and Human Services (DPHHS) runs it. It sorts fee schedules, provider manuals, notices, and billing help by provider type. If you also want to know who can get coverage, read our page on Montana Medicaid income limits.
Don’t ask, “What does Montana Medicaid pay?” Ask this instead: which fee schedule and payment method apply to my service and my date of service?
Montana Medicaid 2027 rate update: What actually changed?
On May 29, 2026, DPHHS shared a notice. It said Montana will not make more broad Medicaid provider rate changes for State Fiscal Year (SFY) 2027. The only changes will be ones that state law, federal rules, or CMS fee schedules require.
The notice names a few groups with federally required rates: FQHCs, RHCs, IHS, and hospice. It also mentions CMS fee schedules that affect DME and ambulatory surgical centers.
Some things are changing. For SFY 2027, Montana plans to use the 2026 RBRVS relative value units. It will also use an updated APR-DRG grouper and national weights.
So if you find an older article that promises a big Montana Medicaid rate increase, don’t treat it as 2027 policy. Check the date first.
| Issue | 2026 | SFY 2027 |
|---|---|---|
| Broad provider adjustment | Existing applicable schedules | No additional broad adjustment announced |
| RBRVS | Existing methodology | 2026 RVUs implemented |
| Inpatient hospital | APR-DRG methodology | Updated grouper/weights |
| FQHC/RHC/IHS/Hospice | Applicable federal/state rules | Required adjustments continue |
| DME/ASC | Applicable CMS schedules | CMS-established requirements continue |
How Montana Medicaid reimbursement rates are determined
For many professional services, Montana Medicaid uses RBRVS. That stands for Resource-Based Relative Value Scale.
Montana’s physician-related services manual explains the basic idea. Each RBRVS fee is usually a relative value times a conversion factor. Montana uses Medicare’s relative values for almost all services. When Medicaid has its own rules, those rules come first.
Here is the formula:
Medicaid fee = Relative value × conversion factor
The final claim can still change because of modifiers, place of service, coverage, provider requirements, and the date of service.
Here’s something many people miss. Montana counts as one locality for RBRVS relative values. Billings, Missoula, Bozeman, Great Falls, and Helena do not get their own. Want to see how other states set their rates? Look at these Medicaid reimbursement rates by state.
How to look up a Montana Medicaid reimbursement rate
To find a Montana Medicaid CPT or HCPCS rate, follow these steps:
- Identify the provider type.
- Identify the CPT, HCPCS, CDT, or applicable revenue code.
- Confirm the date of service.
- Open the appropriate Montana Healthcare Programs provider page.
- Locate the applicable fee schedule, PDF, or Excel file.
- Find the procedure or service code.
- Review modifiers and place-of-service requirements.
- Check coverage and prior authorization requirements.
- Compare the published fee with the final claim or remittance advice.
Montana says to use the current fee schedule for your provider type. Pick the schedule that matches your date of service. The schedules also show markers for coverage, prior authorization, bilateral billing, co-surgery, and other billing cases.
Where to find Montana Medicaid fee schedules
Montana has a Resources by Provider Type page. It lists physicians, dentists, DMEPOS suppliers, ambulatory surgical centers, applied behavior analysis, ambulance providers, nursing facilities, behavioral health providers, therapists, and many more.
Some pages give the fee schedule as both a PDF and an Excel file. The physician page, for example, has January 2026 physician fee schedules in both formats.
This setup matters. There is no one Montana Medicaid fee schedule that works the same for every service.
Montana Medicaid rates by provider type
Each type of service can use its own payment method.
| Provider/service | Main rate resource or methodology |
|---|---|
| Physicians | RBRVS fee schedule |
| Mid-level practitioners | Provider-specific fee schedule/RBRVS |
| Dentists | Dental fee schedule |
| DMEPOS | DMEPOS fee schedule |
| Hospitals | Inpatient/outpatient methodologies |
| Inpatient hospitals | APR-DRG |
| Outpatient hospitals | APC/OPPS-related methodology |
| Nursing facilities | Nursing facility reimbursement rates |
| Therapists | Applicable therapy/RBRVS schedules |
| Behavioral health | Provider/service-specific schedules |
| ABA | ABA fee schedule/methodology |
| Home health | Home health fee schedule |
| HCBS | Service-specific HCBS schedules |
| IHS | IHS fee schedule |
| Tribal 638 | Tribal 638 fee schedule |
| ASCs | Applicable ASC/CMS-established schedules |
| Transportation/ambulance | Provider-specific schedules |
Montana’s provider page shows how much these resources are split up.
Physician, therapy and professional-service reimbursement
For physician-related services, RBRVS, RVUs, CPT, and HCPCS do most of the work.
The rate depends on the code, the relative value, the conversion factor, the modifier, the place of service, and other Medicaid rules.
RBRVS has some exceptions. The physician manual says anesthesia and clinical laboratory services are not paid through the RBRVS fee schedule the way most other CPT services are.
That is why a plain search for a “Montana Medicaid CPT rate” often gives the wrong answer. You need the provider type and the service.
Hospital reimbursement: APR-DRG and APC/OPPS
Hospital claims follow different rules from most professional claims.
For inpatient hospital care, Montana uses APR-DRG. DPHHS announced an updated APR-DRG grouper and national weights for SFY 2027. Outpatient hospital care can use APC/OPPS-related payment methods instead of the physician RBRVS formula.
A hospital should not use a physician fee schedule amount as the Medicaid payment for a facility claim. They are two different systems.
DME, dental, behavioral health and other specialty rates
Montana keeps separate resources for many specialty services:
- DMEPOS
- Dental
- Denturist services
- Behavioral health
- Applied behavior analysis
- Home health
- Nursing facilities
- HCBS
- IHS
- Tribal 638
- Ambulance and transportation
- Laboratory
- Anesthesia
- ASC services
Look at the IHS page. It lists one fee schedule for January and another for July. The effective date tells you which one to use.
Why the published fee may not equal your actual Medicaid payment
A fee schedule does not promise what a claim will pay.
Think of payment in three steps. The published rate is the amount or method in the fee schedule. The expected reimbursement is what you work out after applying the code and payment rules. The actual payment is what Montana Medicaid decides when it processes the claim.
Many things can change that last number:
- CPT/HCPCS/CDT code
- Modifier
- Place of service
- Units
- Provider type
- Coverage
- Prior authorization
- Medical necessity
- Provider enrollment
- Third-party liability
- Medicare coordination
- Bundled services
- Claim documentation
- Applicable payment methodology
So a provider may not get the published fee on every claim.
Calendar year vs. State Fiscal Year
Many people mix up CY 2027 and SFY 2027.
Montana’s provider materials use both January and July effective dates. Different provider groups can follow different schedule periods. Right now, Montana lists January 2026 physician schedules. Other provider pages have July schedules.
Always read the effective date on the fee schedule you use. A file labeled “2027” does not automatically cover every claim filed in calendar year 2027.
What providers should check before billing
Before you send a Montana Medicaid claim, check these: provider type; NPI and enrollment status; CPT, HCPCS, or CDT code; revenue code, if needed; date of service; current fee schedule; modifier; place of service; units; coverage rules; prior authorization; medical necessity; documentation; and timely filing rules.
If a claim pays less or more than you expected, open the remittance advice and the provider manual. A rate from a third-party database is the weakest place to start.
Montana Medicaid rates in rural communities
The payment method is the same across the state. Access to care is not.
Billings, Missoula, Great Falls, Bozeman, Helena, Kalispell, Butte, Havre, and the rural and tribal areas around them can have very different access to providers. Montana’s Medicaid system includes Rural Health Clinics, FQHCs, IHS, Tribal 638 providers, home and community-based services, and transportation help. Provider type matters even more in rural and frontier areas.
A service does not pay differently just because you bill it in one Montana city instead of another.
FAQs About Montana Medicaid Reimbursement Rates
1. What are Montana Medicaid reimbursement rates for 2027?
There is no single rate. Payment changes by provider type, service code, payment method, effective date, modifiers, place of service, coverage, and other claim rules.
2. Did Montana Medicaid increase rates in 2027?
Not across the board. DPHHS said it will make no more broad provider-rate changes for SFY 2027, except those required by state law, federal rules, or CMS fee schedules. It also announced 2026 RBRVS RVUs and an updated APR-DRG grouper and weights.
3. Where can I find the Montana Medicaid fee schedule?
On the Montana Healthcare Programs Resources by Provider Type page. It has fee schedules, provider manuals, notices, and other resources for each provider group.
4. How do I look up a Montana Medicaid CPT code?
Start with your provider type and date of service. Open the matching Montana fee schedule and search for the CPT code. Then check modifiers, coverage, prior authorization, and other billing rules before you trust the listed amount.
5. Does Montana Medicaid use RBRVS?
Yes, for many professional services. It uses relative values and a conversion factor, plus Medicaid-specific rules where they apply.
6. Does a modifier change Montana Medicaid reimbursement?
Yes, it can. Montana’s fee schedules and manuals have billing markers and rules that affect payment. Check the provider manual and fee schedule.
7. Does place of service affect Medicaid payment?
Yes. It is one factor that can change payment. The same procedure code may not pay the same in every setting.
8. What is APR-DRG in Montana Medicaid?
It is a payment method for hospital inpatient stays. Montana announced an updated APR-DRG grouper and national weights as part of its SFY 2027 rate changes.
9. Are Montana Medicaid fee schedule amounts guaranteed payments?
No. Coverage, coding, modifiers, authorization, eligibility, third-party liability, and claim review all affect the final payment.
Conclusion
Montana Medicaid reimbursement rates for 2027 depend on the provider and the service. There is no one statewide price list.
For SFY 2027, DPHHS is not making more broad provider-rate changes. The required exceptions and the method updates, such as new RBRVS relative values and APR-DRG information, are what count. Before you estimate any payment, find your provider type, code, date of service, and fee schedule. Start there.
Official Resources
- Find Your Fee Schedule — Montana Healthcare Programs
- Check Your Claim Status — Montana Healthcare Programs
- Verify Provider Enrollment — Montana Healthcare Programs
- See Medicare RVUs by Code — CMS
Disclaimer: Rates and billing rules change, so don’t bill off memory. Before you send a claim or make any money decision, pull up the current Montana Healthcare Programs fee schedule, provider manual, and provider notice, and look at the effective date on each.
About Naseer
Naseer has 10+ years of experience creating informative content and researching medicare topics. He focuses on simplifying Medicaid and benefits details to support readers find clear, reliable, and easy-to-understand guidance.