Medicare Rate Comparison — SFY 2027 (MAC Locality 0320201)
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Provides Medicare-based rate comparisons (facility, non-facility, limiting charges, and office fees) for multiple CPT/HCPCS E/M and related service codes for Montana MAC locality 0320201; affects providers billing Montana Department of Public Health & Human Services for SFY 2027.
No material clinical or coverage changes in this revision.
Rate Comparison and Listings
Rate comparison — informational
Stance: informational rate comparison; does not state coverage decisions or medical necessity criteria in this excerpt.
Rate listings — collaborative psychiatric care & transitional care management
Rates and settings listed for CPT codes associated with collaborative psychiatric care and transitional care management for MAC locality 0320201.
ALL of the following
- Code: 99492 (initial psychiatric collaborative care management) — Non-Facility Limiting Charge values shown: 175.14, 158.36.
- Code: 99492 — Physician Related Office Fee values shown: 89.76, 225.36; Physician Related Facility Limiting Charge values shown: 158.36, 97.78, 67.14, 39.41; Physician Related Allied Health Facility Fee values shown: 203.76, 125.83, 86.39, 50.71.
ALL of the following
- Code: 99493 (subsequent psychiatric collaborative care management) — Non-Facility Price values shown: 61.45, 220.10; Facility Price values shown: 36.07, 122.23; Non-Facility Limiting Charge values shown: 67.14, 240.46.
- Code: 99493 — Physician Related Office Fee and other provider/setting fees are shown across multiple values (e.g., 39.41, 86.39, 309.40; allied health and mental health fees also listed).
ALL of the following
- Code: 99494 (psych collaborative care complex/add-on or transitional care management lower complexity) — Non-Facility Price values shown: 220.10, 298.59; Facility Price values shown: 122.23, 166.32.
ALL of the following
- Code: 99495 (transitional care management, high complexity, face-to-face within 7 days) — Non-Facility Limiting Charge values shown: 122.23, 240.46, 166.32, 326.21; Office Fee values shown: 133.54, 309.40, 181.71, 419.73; Facility Price values shown: 122.23, 166.32.
CPT/HCPCS Code Tables and Pricing
| 99202-99215 | Office/outpatient E/M new and established visit codes with multiple subcategory rates |
| 99406-99407 | Behavior change smoking cessation codes (3-10 min; >10 min) |
| 99415-99416 | Prolonged clinical staff services and add-on codes |
| 99421-99423 | Online digital E/M services |
| 99424-99427 | Principal care management and staff codes |
| 99439-99453 | Chronic care management, remote monitoring, nutrition/professional services |
| 99454-99458 | Remote physiologic monitoring initial and each additional period |
| 99483-99495 | Assessment & care plan, behavioral health care management, transitional care management, psychiatric collaborative care management |
Authorization and Billing Guidance
No prior authorization required / Authorization not specified
No prior authorization or authorization rules are included in this excerpt; the document provides Medicare rate comparisons by code and provider type for MAC locality 0320201 (Montana).
Rate source identified; no authorization or utilization controls stated
Rates are based on the Medicare Physician Fee Schedule (Medicare rates effective 1/1/2026–12/31/2026); the excerpt does not specify prior authorization, documentation, or step-therapy requirements.
- Source for rates: Medicare Physician Fee Schedule (link shown in sources).
- Proposed Montana Medicaid rate period shown: Effective 7/1/2026–6/30/2027.
Locality and Rate Column Definitions
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