RA Messages for October 2, 2001
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
12/9/00 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF. DATE |
| ALBUTEROL |
AEROSOL |
90MCG |
1.29941 |
09/25/01 |
| ALBUTEROL |
AER REFILL |
90MCG |
1.19941 |
09/25/01 |
| ACETAMIN/CAFF/BUTALB |
CAPSULE |
325-40-50 |
0.39950 |
09/25/01 |
| ACETAMIN/CAFF/BUTALB |
TABLET |
325-40-50 |
0.41445 |
09/25/01 |
| ASPIRIN/CAFF/BUTALB |
CAPSULE |
325-40-50 |
0.63360 |
09/25/01 |
| BENZTROPINE MESYLATE |
TABLET |
0.5MG |
0.07050 |
09/24/01 |
| BENZTROPINE MESYLATE |
TABLET |
1MG |
0.09250 |
09/24/01 |
| BENZTROPINE MESYLATE |
TABLET |
2MG |
0.10270 |
09/24/01 |
| DEXAMETHASONE |
TABLET |
1.5MG (100S +) |
0.29565 |
09/25/01 |
| DEXAMETHASONE |
TABLET |
1.5MG (< 100S) |
OFF MAC |
09/25/01 |
| DISULFIRAM |
TABLET |
250MG |
1.00360 |
09/25/01 |
| INDOMETHACIN |
CAPSULE |
SA 75MG (ALL SIZE) |
OFF MAC |
09/25/01 |
| NEOMYCIN SULFATE |
TABLET |
500MG |
OFF MAC |
09/25/01 |
| PROMETHAZINE |
TABLET |
12.5MG |
OFF MAC |
09/25/01 |
| PROMETHAZINE |
TABLET |
50MG |
0.27180 |
09/25/01 |
| SULFADIAZINE |
TABLET |
500MG |
OFF MAC |
09/25/01 |
PLEASE MAKE THE FOLLOWING CHANGES TO THE
12/9/00 VERSION OF APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 08881 |
LEADER |
10/01/01 |
|
| 10019 |
BAXTER HEALTHCARE CORP. |
10/01/01 |
|
| 36652 |
LEADER |
10/01/01 |
|
| 50557 |
PHARMACEUTICAL VENTURES |
10/01/01 |
|
| 53095 |
ICN PHARMACEUTICALS, INC |
|
10/01/01 |
|
54859 |
LLORENS PHARMACEUTICAL
|
10/01/01 |
|
| 56151 |
LEADER |
10/01/01 |
|
| 62865 |
DRUG EMPORIUM, INC |
|
10/01/01 |
| 66215 |
ACTELION PHARMACEUTICALS |
10/01/01 |
|
LEASE
FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
PROVIDER, PLEASE BE REMINDED THAT YOU CANNOT
ALWAYS BILL THE RECIPIENT FOR A SERVICE ON WHICH YOU'VE RECEIVED A 299 OR 232
DENIAL.
SOME CPT CODES ARE IN A NON-PAYABLE STATUS ON
OUR FILES BECAUSE THEIR SERVICES AS DESCRIBED IN CPT ARE INCLUDED ON OTHER CODES
WHICH ARE COVERED.
WHEN THE DENIED SERVICE IS NOT PAYABLE ON THE
FILE BECAUSE IT IS A COMPONENT OF A PAYABLE SERVICE, IT CANNOT BE BILLED TO THE
RECIPIENT. FOR EXAMPLE, CODE 92015 (DETERMINATION OF REFRACTIVE STATE)
CANNOT BE BILLED TO THE RECIPIENT BECAUSE ITS FEE IS INCLUDED IN THE FEE FOR THE
OFFICE VISIT. THEREFORE, CODE 92015 CANNOT BE BILLED TO THE RECIPIENT IF
DENIED WITH A 299 OR 232. ANOTHER SERVICE WHICH CANNOT BE BILLED TO THE
RECIPIENT IS THE ADMINISTRATION OF AN INJECTION OF A VACCINE FOR WHICH THE
PHYSICIAN HAS TO PAY. BECAUSE THE FEE FOR ADMINISTRATION OF THE VACCINE IS
INCLUDED IN THE FEE FOR THE OFFICE VISIT, THE RECIPIENT CANNOT BE BILLED WHEN
THE ADMINISTRATION CODE IS DENIED.