Performance Audit Report, Administration of Medicaid Fee-Based Services Program, Department of Social And Rehabilitation Services 1985

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PERCENT PAID BY MEDICAID OF NORMALLY BILLED CHARGES Fiscal Year 1983-84 PHYSICIAN!
OTHER PRACTITIONERS DRUGS CENTAL PERCENT Source: MARS reports (July 1984) Illustration 7 Rven though Montana Medicaid rates are substantially lower than providers' billed charges, they are comparable to Medicaid rates of nearby states. We contacted five neighboring states to find out about their reimbursement rates. We collected information on eight procedures that were high in use, and/or in dollars ex- pended,
...under Montana's Medicaid program. This information is summarized in Illustration 8.
22 REIMBURSEMENT OF COMMON PROCEDURES Procedure Number Procedure MT WY SD OR ID ND 90050 Office visit for estab- lished patient $15.07 $20.00 $14.00 $14.35 $15.60 $15.00 90010 Office visit for initial visit 28.24 25.00 17.00 26.81 25.80 16.50 90753 Preventive Health Care (ages 5-11) 28.24 20.00 25.00 N/E M/D 15.00 90841 Medical Psychotherapy 18.84 17.50 15.00 N/C^^ 20.70 18.75 92014 Comprehensive Opthalmol- ogical Services 27.98 31.10 29.10 44.82 37.50 29,80 93000 Electrocardiogram 28.24 30.00 25.00 21.45 24.00 29.60 2110 Amalgam Restorations 16.26 20.00 12.50 11.52 13.00 13.00 111 Preventative Diagnostic Services 10.30 12.00 9.00 10.43 10.00 9.00 No fee established ^'Manually determined 3 Not a covered service Source: Compiled by the Office of the Legislative Auditor Illustration 8 Vie also compared Medicaid pharmacy dispensing fees with those of nearby states.


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