PHARMACY PROVIDERS, PLEASE NOTE!!!

If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in Appendix C, available at http://www.lamedicaid.com/. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

ATTENTION REHABILITATION CENTERS, OUTPATIENT HOSPITAL REHABILITATION AND SCHOOL-BASED HEALTH CENTERS

Effective March 1, 2013, the definition for procedure code(s) 92507 and 92508 are being updated to reflect the appropriate CPT code definition and remove the 15 minute increment as listed on the Louisiana Medicaid Fee Schedules.

The rates are being updated in accordance with the definition per occurrence/visit. Only one occurrence may be billed per day. Providers should check with the appropriate health plans for billing instructions on previous dates of service since implementation of Bayou Health, February 2012.

Please see the updated Rehabilitation Services Fee Schedule on http://www.lamedicaid.com.

OUTPATIENT HOSPITAL PROVIDERS: PULSE OXIMETRY CLAIMS

Effective with the March 26, 2013 date of processing, outpatient hospital claims for noninvasive ear or pulse oximetry (CPT code 94760) will be processed through the ClaimCheck clinical editing product, and subject to the same editing as professional claims. Providers can expect that pulse oximetry claims will be considered integral/incidental to other allowed services performed on the same date and in most instances will not be separately reimbursed. This update provides consistency in Medicaid policy among provider types.

For questions related to this information, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.

ATTENTION DURABLE MEDICAL EQUIPMENT PROVIDERS

Please note the DME HCPCS code E1091 (Youth wheelchair, any type) is being discontinued effective 4/30/13. The appropriate code should be submitted to prior authorization (PA) requests dated 5/1/13 forward.

If you have any questions, please contact Molina Prior Authorization at 225-928-5263 or 1-800-488-6334.

Attention Professional Services Providers:
Medical Review Required for CPT Code 64615

Effective with dates of service beginning April 15, 2013, Medical Review is required for Current Procedural Terminology (CPT) code 64615 (Chemodenervation of muscle(s): innervated by facial...for chronic migraine) to determine if the following criteria have been met prior to allowing payment. For the treatment to be reimbursed using this code, documentation must be submitted with the claim that demonstrates that the patient meets these criteria related to chronic migraine:

  • Fifteen or more days of headache or a headache that lasts 4 hours or more per day over 30 days

Please visit http://www.lamedicaid.com for the notice. If you have any questions please contact Molina Provider Relations at (800)473-2783 or (225)924-5040.