RA Messages for October 3, 2000

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 5/15/00 VERSION OF APPENDIX A:

PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE LOUISIANA MEDICAID PROGRAM WILL REIMBURSE SURGEONS FOR THE USE OF AN OPERATING MICROSCOPE (CPT CODE 69990) ONLY IN SITUATIONS WHICH JUSTIFY ITS USE.  SOME CLAIMS HAVE BEEN RECEIVED FROM PROVIDERS BILLING FOR CODE 69990 IN ADDITION TO CODE 69436 (TYMPANOSTOMY, GENERAL ANESTHESIA).  IF A PROCEDURE IS CONSIDERED ROUTINE BY THE PHYSICIAN - CONSULTANTS, CODE 69990 WILL BE DENIED WITH ERROR EDIT 774 - INCLUDED IN RELATED PROCEDURE.