Montana Medicaid Fee Schedule 2026: Rates, Updates & Provider Guide

Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Montana DPHHS and Medicaid.gov guidelines | Last Updated: April 2026

Montana Medicaid updated its fee schedules for 2026 with a 3.0% provider rate increase that took effect July 1, 2025 (State Fiscal Year 2026).

This increase covers most provider types — from physicians and dentists to nursing facilities and therapists.

This guide breaks down every key rate, conversion factor, and update you need to know for 2026.

Quick Summary:

• ✅ Montana’s 3.0% Medicaid rate increase is live as of July 1, 2025
• ✅ Physician RBRVS conversion factor: $45.41 (up from $43.96 in FY 2025)
• ✅ Nursing facility flat-rate: $287.11 per Medicaid patient day for SFY 2026
• ✅ New PT, OT, and SLP rates set under House Bill 585 (2025)
• ✅ Fee schedules are posted at medicaidprovider.mt.gov

What Is the Montana Medicaid Fee Schedule?

The Montana Medicaid fee schedule is the official list of payment rates for healthcare services covered by Montana’s Medicaid program. It tells providers exactly how much they will be paid for each service they provide to Medicaid patients.

Montana’s Department of Public Health and Human Services (DPHHS) manages these fee schedules under the Montana Healthcare Programs umbrella. All schedules are published at medicaidprovider.mt.gov and are updated twice per year — on January 1 and July 1.

2026 Legislative Authority and Rate Increases

The 2025 Montana Legislature passed House Bill 2 (HB 2), the state’s general appropriations act. This bill funded a 3.0% Medicaid provider rate increase for both SFY 2026 and SFY 2027. Governor Gianforte signed HB 2 in June 2025, and the first rate increase took effect July 1, 2025.

This was a major win for Montana providers. Here is what the 2025 Legislature approved:

3.0% Across-the-Board Rate Increase

The 3.0% increase covers most provider types, including physician services, therapy, dental, behavioral health, home health, and long-term care. The total cost over the two-year biennium is $140.9 million in all funds, including $47.4 million in general fund dollars.

Part C IDEA Provider Rate Alignment

An additional $4.3 million over the biennium was approved to align Part C IDEA (early intervention) provider rates with benchmarks from the Guidehouse Rate Study. This helps ensure early intervention providers are paid closer to their actual costs.

Area Agencies on Aging Increase

The Legislature also approved a $4 million biennial increase for Area Agencies on Aging. These agencies serve elderly Montanans with home and community-based services.

House Bill 585 — Therapy Rate Reform

HB 585 changed how Montana pays for physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP). These services moved to a conversion factor and RVU methodology — the same system used for physician services. Before HB 585, providers were losing money on every hour of therapy. Legislators found that PT providers lost about $44/hour, SLPs about $68/hour, and OTs about $51/hour under the old system.

Montana Medicaid Conversion Factors for 2026

Montana Medicaid uses conversion factors (CFs) and Relative Value Units (RVUs) from the Medicare RBRVS system to calculate payment for most professional services. These are the confirmed conversion factors for FY 2026.

Understanding these numbers matters for every provider submitting claims. The payment formula is simple: RVU × Conversion Factor × Policy Adjuster = Payment. Refer to the Medicaid Fee Schedule 2026 resource for a full national comparison of how Montana stacks up against other states.

Physician and Anesthesia Conversion Factors

For comparison: the physician RBRVS conversion factor in FY 2025 was $43.96. The increase to $45.41 reflects the legislated 3.0% rate bump.

Therapy and Outpatient Conversion Factors

Montana Medicaid Nursing Facility Rates for SFY 2026

Montana uses a flat-rate plus quality component system for nursing facility payments. The flat-rate base is the same for every facility, and the quality add-on depends on CMS five-star ratings for staffing and quality measures.

These rates have climbed significantly over the past three fiscal years. Before the 2023 reform, the per-diem was just $212 — roughly 22% below benchmark costs identified by the Guidehouse consulting firm.

SFY 2026 Nursing Facility Per-Diem Rates

For context, the flat-rate in SFY 2025 was $278.75 — meaning SFY 2026 adds about $8.36 per patient day. SFY 2026 is the final year of a three-year ramp-up from $212 to the $287–$295 range.

Fee Schedules Published or Updated in Calendar Year 2026

Montana DPHHS posted a large number of fee schedule updates in early 2026. Some covered new January 1, 2026 (calendar year) rates. Others were retroactive postings for July 1, 2025 (SFY 2026) schedules. DPHHS often processes and publishes schedules one to four weeks before or after their effective date.

January 2026 (Calendar Year) Fee Schedules

These schedules were posted between January and April 2026 and carry an effective date of January 1, 2026:

SFY 2026 (July 2025) Schedules Posted in Early 2026

These schedules carry an effective date of July 1, 2025 but were posted retroactively in early 2026:

Proposed Fee Schedule: Youth Mental Health (May 2026)

DPHHS issued a proposed fee schedule under MAR Notice 2026-525.1, with a proposed effective date of May 9, 2026. The proposed Youth Mental Health Fee Schedule was posted for public comment on March 23, 2026, through Montana’s Administrative Rules (ARM) process.

This rulemaking is still active. The final adopted rate had not been confirmed as of April 2026. Providers offering youth mental health services should monitor medicaidprovider.mt.gov/proposedfs for the final notice.

PRTF Rates: Federal Approval for SFY 2026

The Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment MT-25-0013. This approval updated reimbursement fee schedules for Psychiatric Residential Treatment Facility (PRTF) services for State Fiscal Year 2026.

This federal sign-off confirms Montana’s revised inpatient psychiatric rates for youth served in residential treatment settings are now in effect. Providers billing PRTF services should use the updated rates as directed by DPHHS.

How Montana Medicaid Calculates Reimbursement

Montana uses several methods to set rates, depending on the type of provider. Knowing your methodology helps you understand how your payment is calculated and how changes in conversion factors affect your bottom line. You can also compare Montana’s approach against other states by reviewing medicaid income limits by state in 2026, which provides useful context on how funding levels differ across the country.

RBRVS (Physician and Therapy Services)

Montana uses the Resource-Based Relative Value Scale (RBRVS) for physician, mid-level, and therapy services. The formula is: RVU × Conversion Factor × Policy Adjuster = Payment.

APC (Hospital Outpatient and ASC)

Ambulatory Payment Classification (APC) is used for hospital outpatient and ambulatory surgery center (ASC) services. Payment equals the APC weight multiplied by Montana’s conversion factor — $62.54 for January 2026.

Per-Diem (Nursing Facilities)

Nursing facilities are paid a flat per-diem rate plus a quality component. The flat-rate is the same for all facilities. The quality add-on varies based on CMS five-star ratings.

Medicare-Prevailing Fee (Lab, DME, Ancillary)

Laboratory services are reimbursed at 60–62% of the listed Medicare fee. DME and certain ancillary services follow a similar Medicare-prevailing approach.

Medicaid-Specific Fee Schedule (Behavioral Health, Dental)

For services where Medicare does not assign RVUs — like certain behavioral health and dental codes — Montana uses a Medicaid-specific fee schedule. These rates are set independently by DPHHS.

Important rule: Montana Medicaid always pays the lower of the provider’s actual charge or the Medicaid fee schedule rate.

Upcoming Eligibility Changes That Will Affect Providers (July 2026)

Starting July 1, 2026, Montana Medicaid will implement significant eligibility changes that will directly impact provider revenue. These changes stem from H.R. 1 (One Big Beautiful Bill Act), signed by President Trump in 2025. Providers should plan now for potential reductions in covered Medicaid patient volume.

Community Engagement (Work) Requirements

Adults aged 19–64 on Medicaid expansion must document at least 80 hours per month of work, education, job training, volunteering, or other approved activities. Montana is implementing this six months ahead of the federal deadline of January 1, 2027.

DPHHS has stated it will not disenroll beneficiaries for the first three months (July–September 2026). Enforcement disenrollments are expected to begin October 2026.

How Many Patients Could Lose Coverage?

An estimated 4,000 Montanans — about 4–6% of Medicaid expansion enrollees — are currently not working and may not qualify for an exemption. Exempted groups include:

• Adults age 65 and older
• Pregnant women
• Parents of children under age 13
• American Indians
• Those determined “medically frail”

More Frequent Eligibility Redeterminations

Eligibility redetermination will shift from annually to every six months. Hospitals and providers should expect higher churn in their Medicaid patient population starting in late 2026.

Where to Access Official Montana Medicaid Fee Schedules

All current fee schedules, coversheets, and provider notices are available only through official government sources. DPHHS does not publish individual CPT-level rate summaries outside the full fee schedule PDF or Excel files — you must review the applicable document directly.

What Is Not Yet Confirmed for 2026

Some information was not publicly available as of April 2026. Providers should monitor DPHHS for these updates.

• July 1, 2026 fee schedule rates — The second 3.0% increase for SFY 2027 has not yet been published. DPHHS typically posts these 1–4 weeks before or after July 1.
• Final Youth Mental Health Fee Schedule (MAR 2026-525.1) — The final adopted version of the proposed May 2026 schedule has not been confirmed.
• Procedure-level CPT rates — Individual procedure rates require direct review of the applicable DPHHS fee schedule document.
• Impact of federal Medicaid budget reconciliation — As of April 2026, Congress is still debating federal Medicaid funding changes that could affect future Montana rate increases.

FAQ: Montana Medicaid Fee Schedule 2026

Sources & Disclaimer

Sources:

• Montana DPHHS – Medicaid Provider Fee Schedules: medicaidprovider.mt.gov
• Montana DPHHS – Provider Rate Study: dphhs.mt.gov/providerratestudy
• Medicaid.gov – State Plan Amendments and Federal Guidance: medicaid.gov

Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility and billing guidance, contact the Montana Department of Public Health and Human Services or visit Medicaid.gov.

Last Updated: April 2026 | Written & Reviewed by Akash Biswas, MSW — Former Medicaid Caseworker Trainer | 10+ years Medicaid policy experience