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 Ordering Providers and Providers of Laboratory Services

Effective for dates of service on or after July 1, 2019, Louisiana Medicaid has adopted the following changes to the coverage of Urine Drug Testing:

  • Presumptive drug testing is limited to 24 total tests per member per calendar year. Providers are to consider the methodology used when selecting the appropriate procedure code for the presumptive testing

  • Definitive drug testing is limited to 18 total tests per member per calendar year. CPT codes 80320-80377 for individual substance(s) or metabolites will no longer be covered. Providers should instead use HCPCS codes G0480 (Drug tests, definitive…per day 1-7 drug class(es), including metabolite(s) if performed) or G0481 (Drug tests, definitive…per day, 8-14 drug class(es), including metabolite(s) if performed) or their successors.

Testing more than fourteen definitive drug classes per day is not reimbursable.

No more than one presumptive and one definitive test will be reimbursed per day per recipient, from the same or different provider.

Information regarding this policy is forthcoming and will be found on www.lamedicaid.com under the Provider Manuals link, within the Professional Services and Independent Laboratory Services manuals. Fee schedules will be updated accordingly and can be found at the appropriate link on www.lamedicaid.com.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473-2783 or (225) 924-5040. Questions regarding managed care claims should be directed to the appropriate Managed Care Organization.

Attention Durable Medical Equipment (DME) Providers

Effective with date of service June 1, 2019, Medicaid guidelines for oxygen probes for use with an oximeter device are being updated. DME providers will submit the appropriate HCPCS code from the DMEPOS fee schedule to bill for these supplies. The rate on file for the HCPCS code includes reimbursement for the tape. The U5 modifier (oxygen probe for use with oximeter device, disposable) must be included on the prior authorization and claim for disposable oxygen probes. If the DME provider bills for a replacement oxygen probe, a modifier would not be used.

Medicaid will publish the new oxygen probe policy in the DMEPOS provider manual on www.lamedicaid.com.

Questions regarding this message and fee for service claims should be directed to DXC Technology Provider Relations at (800) 473‐2783 or (225) 924‐5040. Questions regarding managed care claims should be directed to the appropriate managed care organization.