Montana Medicaid Reimbursement Rates
What Medicaid pays for medical procedures and services in Montana, based on 2024 claims data.
2024 Overview
Procedures
1.1K
Total Claims
10.6M
Total Paid
$955.6M
Popular Services
Procedures
Showing 51–100 of 1,145 procedures, sorted by most claims.
| HCPCS Code | Description | Total Claims | Avg Payment | Min Payment | Max Payment |
|---|---|---|---|---|---|
| H0040 | Assert comm tx pgm per diem | 23,524 | $325.96 | $246.60 | $356.95 |
| J2405 | Ondansetron hcl injection | 22,586 | $0.44 | $0.00 | $8.98 |
| D8670 | Periodic orthodontc tx visit | 22,514 | $79.92 | $10.52 | $110.49 |
| T2021 | Day habil waiver per 15 min | 22,506 | $969.15 | $45.97 | $3,567.66 |
| H0018 | Alcohol and/or drug services | 22,003 | $515.33 | $231.69 | $2,745.31 |
| T2022 | Case management, per month | 21,824 | $326.09 | $287.85 | $347.56 |
| D0220 | Intraoral periapical first | 21,368 | $13.47 | $0.00 | $24.98 |
| T2016 | Habil res waiver per diem | 21,336 | $458.46 | $104.84 | $8,650.71 |
| D0274 | Bitewings four images | 21,311 | $30.29 | $0.00 | $71.11 |
| D1330 | Oral hygiene instructions | 20,870 | $22.27 | $0.00 | $37.19 |
| D2392 | Post 2 srfc resinbased cmpst | 20,769 | $119.58 | $0.00 | $195.68 |
| D1310 | Nutri counsel-control caries | 20,458 | $37.59 | $0.00 | $52.49 |
| 71046 | X-ray exam chest 2 views | 20,456 | $6.51 | $0.00 | $71.30 |
| 92014 | Compre oph exam est pt 1/> | 20,356 | $94.22 | $0.00 | $166.16 |
| 85027 | Complete cbc automated | 20,170 | $0.64 | $0.00 | $6.51 |
| 88305 | Tissue exam by pathologist | 19,936 | $44.91 | $0.00 | $185.11 |
| 92340 | Fit spectacles monofocal | 19,470 | $27.61 | $0.00 | $40.57 |
| 90471 | Immunization admin | 19,216 | $11.08 | $0.00 | $25.12 |
| 99215 | Office o/p est hi 40 min | 19,115 | $140.90 | $0.00 | $266.60 |
| 96375 | Tx/pro/dx inj new drug addon | 18,821 | $2.06 | $0.00 | $46.39 |
| 82306 | Vitamin d 25 hydroxy | 18,540 | $2.86 | $0.00 | $33.87 |
| 87086 | Urine culture/colony count | 17,867 | $1.03 | $0.00 | $16.33 |
| 90833 | Psytx w pt w e/m 30 min | 17,738 | $70.12 | $0.00 | $106.25 |
| H0016 | Alcohol and/or drug services | 17,558 | $148.43 | $127.75 | $245.88 |
| E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, | 17,172 | $13.78 | $2.73 | $30.15 |
| 83690 | Assay of lipase | 16,605 | $0.98 | $0.00 | $13.63 |
| 80048 | Basic metabolic pnl total ca | 16,422 | $0.86 | $0.00 | $8.91 |
| J1885 | Ketorolac tromethamine inj | 15,941 | $0.35 | $0.00 | $7.65 |
| S0215 | Nonemerg transp mileage | 15,618 | $15.07 | $0.44 | $232.02 |
| A0080 | Noninterest escort in non er | 15,616 | $11.05 | $3.51 | $34.24 |
| 74177 | Ct abd & pelvis w/contrast | 15,247 | $47.99 | $0.00 | $329.79 |
| Q9967 | Locm 300-399mg/ml iodine,1ml | 15,238 | $1.68 | $0.00 | $36.17 |
| 99282 | Emergency dept visit sf mdm | 15,125 | $18.41 | $0.00 | $77.96 |
| 84484 | Assay of troponin quant | 14,925 | $0.34 | $0.00 | $8.25 |
| H0038 | Self-help/peer svc per 15min | 14,801 | $58.98 | $0.00 | $144.54 |
| G0481 | Drug test def 8-14 classes | 14,798 | $142.90 | $32.03 | $156.58 |
| 86140 | C-reactive protein | 14,734 | $1.63 | $0.00 | $16.88 |
| J3010 | Fentanyl citrate injection | 14,541 | $0.61 | $0.00 | $11.25 |
| A7038 | Pos airway pressure filter | 14,397 | $4.98 | $0.00 | $9.12 |
| S5102 | Adult day care per diem | 14,349 | $387.35 | $113.02 | $1,234.06 |
| J2704 | Inj, propofol, 10 mg | 14,169 | $0.85 | $0.00 | $20.92 |
| Q3014 | Telehealth facility fee | 13,766 | $22.81 | $0.00 | $29.96 |
| D0150 | Comprehensve oral evaluation | 13,671 | $26.51 | $0.00 | $68.01 |
| D0330 | Panoramic image | 13,652 | $48.79 | $0.00 | $125.90 |
| D9630 | Drugs/meds disp for home use | 13,635 | $14.38 | $0.00 | $19.19 |
| 90791 | Psych diagnostic evaluation | 13,480 | $63.65 | $0.00 | $159.23 |
| D0230 | Intraoral periapical ea add | 13,468 | $9.36 | $0.00 | $37.72 |
| J7120 | Ringers lactate infusion | 13,466 | $0.40 | $0.00 | $16.77 |
| 96372 | Ther/proph/diag inj sc/im | 13,435 | $1.32 | $0.00 | $27.40 |
| J7030 | Normal saline solution infus | 13,370 | $0.63 | $0.00 | $11.97 |