The Montana Medicaid fee schedule pays $133.81 for code 99213, a level-3 return office visit, effective July 1, 2026. That ranks second of 46 states and is well above the $75.27 national median, and above Medicare's own non-facility rate of $95.19. For many physician and therapy codes, Montana Medicaid pays more than Medicare does. The exception is autism services, where Montana ranks near the bottom.
MedicaidRate tracks 141,671 current Montana Medicaid reimbursement rates across 134 service categories, compiled from 77 official publications with rate history back to 2007. Every rate links to its source document.
Montana publishes its rates under the Montana Healthcare Programs name, as a set of workbooks updated in July and January:
- Montana Healthcare Programs fee schedule: RBRVS July 2026, the core physician workbook
- July 2026 Mid-Level Fee Schedule and July 2026 Psychiatrist Fee Schedule
- Outpatient Prospective Payment System Procedure Fee Schedule (July 2026)
- ASC Covered Surgical and Ancillary Services fee schedule (July 2026)
- July 2026 DME Fee Schedule and July 2026 IDTF Fee Schedule
- January 2026 Physician Fee Schedule
Physician and practitioner services account for 77,166 rates, radiology and imaging 22,078, and hospital outpatient 20,639. Radiology and hospital outpatient are large because the OPPS procedure fee schedule and the RBRVS workbook list rates code by code, so imaging centers and hospital outpatient departments can look up a specific rate for most services they perform.
Programs
Nearly all rates, 141,262, belong to Montana Medicaid and HMK Plus (fee-for-service). Smaller programs include the Developmental Disabilities Program 0208 Comprehensive Waiver, the Big Sky Waiver for elderly and physically disabled adults, a waiver for adults with severe disabling mental illness, Community First Choice and Personal Care Services, Indian Health Service and Tribal 638 facility rates, the state-funded Mental Health Services Plan, and the HEART section 1115 demonstration.
Montana's physician rates come from an RBRVS workbook, the same method Medicare uses. Because each code's fee follows from its relative value units, the rates move together: when Montana sets its conversion factor above Medicare's, nearly every code in the workbook lands above Medicare too. That is why the office, emergency, preventive and psychotherapy codes all rank near the top at once.
Two practical points follow. First, a July update to the workbook can move thousands of codes at once, so the July 1 fee schedule update is the single most important date on the Montana calendar. Second, separate workbooks for mid-level practitioners and psychiatrists mean the provider type on the claim matters. A nurse practitioner and a physician billing the same code may be priced from different files.
| Code | Service | Montana rate | National median | Rank |
|---|---|---|---|---|
| 99213 | Return visit, level 3 | $133.81 | $75.27 | 2 of 46 |
| 99214 | Return visit, level 4 | $190.62 | $108.69 | 2 of 46 |
| 90837 | Psychotherapy, one hour | $234.75 | $132.38 | 4 of 48 |
| 97110 | Therapeutic exercise, 15 min | $36.76 | $24.36 | 3 of 48 |
| 59400 | Global obstetric care | $3,111.80 | $2,092.38 | 4 of 40 |
| 97153 | ABA by technician, 15 min | $11.36 | $15.86 | 36 of 42 |
Office, emergency and preventive visits
Every evaluation and management code ranks second or third. Code 99215 pays $270.43 against Medicare's $192.38. New-patient visits 99203 and 99204 pay $165.26 and $249.30. Emergency department code 99285 pays $240.81, fourth of 48. The adult preventive visit under 99396 pays $181.23, third of 46.
For a physician practice, this is a rare position: Medicaid pays more than Medicare on the core visit codes. Practices in Montana can treat Medicaid as a full-margin payer, and recruiting arguments for rural clinics can rest on that.
Obstetrics
Global obstetric care pays $3,111.80, fourth of 40. For obstetric practices and family physicians who deliver, that rate makes Medicaid births one of the better-paid lines in the state.
Behavioral health clinicians fare just as well. Code 90834 pays $160.10, fourth of 47, and 90791 pays $243.67, third of 44, both above Medicare. For a therapist or psychiatric practice, Montana Medicaid ranks among the top four states on every common psychotherapy code.
Montana also runs a waiver for adults with severe disabling mental illness and a state-funded Mental Health Services Plan for people not eligible for Medicaid. School-based services are changing: MAR Notice 2026-525.2 restructured CSCT and HSS rates effective August 22, 2026. Agencies that deliver comprehensive school and community treatment should review the new rate structure against their staffing model. See Montana behavioral health rates.
Physical therapy is one of Montana's strongest lines. Therapeutic exercise under 97110 pays $147.04 an hour, third of 49 and 53.1% above the median, at 126% of Medicare. For an outpatient therapy clinic, that makes Montana one of the few states where Medicaid pays above Medicare on timed treatment codes. See Montana therapy Medicaid rates.
Autism providers face a very different picture. Technician ABA under 97153 pays $45.44 an hour, 36th of 42 states and 28.4% below the national median. Analyst-directed treatment under 97155 pays $20.46 per unit, 34th of 41. Only the assessment code 97151 ranks well, at $40.41 per unit, eighth of 41.
ABA rates carry a July 1, 2025 effective date, while physician rates were updated July 1, 2026. The contrast with physical therapy is striking for a state that otherwise pays near the top: ABA providers should not assume Montana's general rate position applies to them. See the Montana ABA Medicaid rates page.
Montana does not contract comprehensive managed-care plans. Every program on file is fee-for-service, no managed-care service lines have been classified, and no state directed payment programs are on record. The published Montana Healthcare Programs rate is what a provider is paid.
Primary Care Montana
The plan and program names that do appear in Montana documents are Primary Care Montana (PCMT) Tier 1 and Tier 2, Team Care, the Tribal Health Improvement Program (THIP), and Blue Cross and Blue Shield of Montana as the HMK third-party administrator. Primary Care Montana replaced Passport to Health, CPC+ and PCMH effective July 1, 2026. It is a primary care case management program, not a risk-bearing plan: practices are paid the fee schedule plus per-member-per-month payments. The enrollment deadline was extended as a final opportunity for retroactive PMPM payments. See the Montana managed care page.
- Private duty nursing: RN care under S9123 pays $87.44 an hour, seventh of 43 and 59.4% above the median. See Montana private duty nursing rates.
- Personal care: agency T1019 pays $36.92 an hour, eighth of 27 and 21.0% above the median. See Montana home care rates.
- Skilled nursing: $220.15 a day, 17th of 21 and 22.1% below the median.
- IDD: in-home and community living supports under H2015 pay $44.75 per staff hour.
The weaker lines are outside the RBRVS workbook. Advanced life support ambulance under A0427 pays $300.95, 26th of 44 and below the $387.24 median, and nursing facilities rank 17th of 21.
In effect
- July 1, 2026 fee schedule updates, which set the current RBRVS, mid-level, psychiatrist, OPPS, ASC, DME and IDTF rates.
- Non-emergency medical transportation changes, including enrollment, billing and accessibility, effective October 1, 2026, with a transportation state plan amendment posted September 21, 2026.
- MAR Notice 2026-8.2, amending hospice reimbursement rules, effective September 5, 2026.
- HMK/CHIP annual dental limit eliminated, effective July 1, 2026.
- Hemodiafiltration billing and reimbursement guidance, effective July 1, 2026.
Proposed
- DDP waiver rates for SFY2027, a draft rates and billing manual with a recorded change of -0.07%, essentially flat.
- State plan amendments for inpatient hospital, outpatient hospital, outpatient drug and clinic services, posted for comment June 30, 2026.
| State | 99213 | 97153 (15 min) |
|---|---|---|
| Montana | $133.81 | $11.36 |
| New Mexico | $128.92 | $32.31 |
| Utah | $122.78 | $19.67 |
| Idaho | $86.12 | not published |
| Wyoming | $79.31 | $12.30 |
Montana pays the most in the Mountain region for an office visit, ahead of New Mexico and Utah, and far above Colorado ($73.99), Arizona ($48.68) and Nevada ($47.47). For ABA the order reverses: Montana's $11.36 per unit is the lowest in this group. A practice deciding where to expand in the region should weigh Montana as a top-tier state for medical, therapy and behavioral health services and a bottom-tier one for autism care.
- Budgeting. Use the July 2026 workbook that matches your provider type. Physician, mid-level and psychiatrist rates come from different files.
- Payer strategy. With no managed-care layer, Montana Medicaid revenue depends on the published rate and PCMT payments. Practices eligible for PCMT should confirm enrollment.
- Benchmarking. Medicare is the natural comparison for physician, therapy and behavioral health codes, since Montana pays above it on many. For ABA and nursing facilities, compare with neighboring states instead.
- Monitoring. The July fee schedule update and MAR notices drive most changes. Proposed waiver rates and SPAs carry comment periods.
All 141,671 current Montana rates, with history back to 2007, are available with a MedicaidRate plan.
Montana rates on MedicaidRate are compiled from official state Medicaid publications, and each rate links to its source document. Named sources include the Montana Healthcare Programs RBRVS July 2026 workbook, the July 2026 Mid-Level, Psychiatrist, DME and IDTF fee schedules, the Outpatient Prospective Payment System Procedure Fee Schedule, the ASC fee schedule and the January 2026 Physician Fee Schedule. National medians and ranks compare the same code and unit across states that publish it; see our methodology.