RA Messages for October 12, 1999
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
MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| BUTOCONAZOLE NITRATE |
CRM/PF APP |
20% |
|
10/01/99 |
| CALFACTANT |
VIAL |
35MG/ML |
|
08/24/99 |
| ERYTHROMYCIN ESTOLATE |
CAPSULE |
250MG |
OFF MAC |
10/04/99 |
| FOLIC ACID |
TABLET |
1MG |
$0.03750 |
10/04/99 |
| IBUPROFEN |
TABLET |
400MG |
$0.16160 |
10/04/99 |
| IBUPROFEN |
TABLET |
600MG |
$0.22658 |
10/04/99 |
| IBUPROFEN |
TABLET |
800MG |
$0.29020 |
10/04/99 |
| LIDOCAINE |
ADH PATCH |
5% |
|
09/15/99 |
| LINDANE |
LOTION |
1% 60'S |
$0.09983 |
10/04/99 |
| LINDANE |
LOTION |
1% OTH SIZES |
OFF MAC |
10/04/99 |
| LINDANE |
SHAMPOO |
1% 60'S |
$0.09983 |
10/04/99 |
| LINDANE |
SHAMPOO |
1% OTH SIZES |
OFF MAC |
10/04/99 |
| MINOXIDIL |
TABLET |
2.5MG |
$0.33250 |
10/04/99 |
| MINOXIDIL |
TABLET |
10MG |
$0.54000 |
10/04/99 |
| ONDANSETRON HCL |
TABLET |
24MG |
|
09/20/99 |
| PIOGLITAZONE HCL |
TABLET |
15MG;30MG;45MG |
|
10/01/99 |
| PIROXICAM |
CAPSULE |
10MG |
$1.25750 |
10/04/99 |
| PIROXICAM |
CAPSULE |
20MG |
$2.15190 |
10/04/99 |
| RANITIDINE HCL |
TABLET |
150MG |
$1.47150 |
10/04/99 |
| RANITIDINE HCL |
TABLET |
300MG |
$2.56672 |
10/04/99 |
| VALPROIC ACID |
CAPSULE |
250MG |
$0.59000 |
10/04/99 |
| ZALEPLON |
CAPSULE |
5MG;10MG |
|
08/20/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
PHARMACY PROVIDERS
POS CLAIMS SUBMITTED WITH THE 16 DIGIT CARD HOLDER NUMBER (CCN)
AND A '2' IN THE 'ELIGIBILITY
OVERRIDE CLARIFICATION CODE' FIELD WILL DENY WITH
EDIT 215.
NOTICE TO PROVIDERS
LUPRON DEPOT 7.5 MG USED IN TREATMENT OF ADVANCED PROSTATIC
CANCER IS NOW AVAILABLE AS A 4 MONTH DOSAGE OPTION. LUPRON CPT CODE J9217,
PREVIOUSLY WAS AVAILABLE ONLT AS 1 AND 3 MONTH OPTIONS.
NOTICE TO PROVIDERS
THE FOLLOWING CODES HAVE BEEN MADE PAYABLE FOR CROSSOVER
CLAIMS EFFECTIVE WITH DATE OF SERVICE GIVEN:
| G0125 |
PET LUNG |
EFFECTIVE WITH DATE OF SERVICE 4/01/1998 |
| G0126 |
PET LUNG |
EFFECTIVE WITH DATE OF SERVICE 4/01/1998 |
| G0163 |
PET COLORECTAL |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
| G0164 |
PET LYMPHOMA |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
| G0165 |
PET MELANOMA |
EFFECTIVE WITH DATE OF SERVICE 7/01/1998 |
NOTICE TO HOSPITALS
ON JULY 30, 1999, A MEMORANDUM WAS ISSUED REGARDING OUTPATIENT CODING FOR PPS
DATA COLLECTION. IF YOU ARE SUBMITTING A CPT/HCPCS WITH A REVENUE CODE, DO
NOT SUBMIT THAT SAME REVENUE CODE WITHOUT A CPT/HCPCS ON THE SAME CLAIM
FORM. IF YOU DO, THE REVENUE CODE WITHOUT THE HCPCS WILL DENY.