RA Messages for November 13, 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.

NOTICE TO CERTIFIED NURSE PRACTITIONERS

EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2001, THE FOLLOWING CPT CODE
WILL BE ADDED TO THE LIST OF CODES PAYABLE TO CERTIFIED NURSE PRACTITIONERS - 31515 - LARYNOGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION. 

NOTICE TO KIDMED PROVIDERS

THE VACCINE ADMINISTRATION FEE ($9.45) INCLUDES MONITORING FOR REACTIONS AND THE ROUTINE TASKS ASSOCIATED WITH VACCINE ADMINISTRATION. THERE SHOULD NOT BE A NEED TO BILL A NURSE CONSULT OR AN OFFICE VISIT IF THE CHILD IS COMING IN TO GET ONLY AN IMMUNIZATION. PLEASE BE AWARE THAT THE ADMINISTRATION OF AN INJECTION IS INCLUDED IN THE OFFICE VISIT FEE.  

NOTICE TO ALL PROVIDERS

THIS IS TO INFORM ALL PROVIDERS THAT EFFECTIVE MARCH 1, 2002, LOUISIANA MEDICAID WILL EXPAND THE COMMUNITYCARE PROGRAM TO INCLUDE LIVINGSTON, ST HELENA, ST. TAMMANY, TANGIPAHOA, AND WASHINGTON PARISHES. MEDICAID RECIPIENTS IN THESE PARISHES WILL RECEIVE LETTERS EARLY IN FEBRUARY ADVISING THEM TO CHOOSE A PRIMARY CARE PROVIDER IN THEIR PARISH OR A CONTIGUOUS PARISH. THESE LETTERS WILL INCLUDE A LIST OF COMMUNITYCARE ENROLLED PROVIDERS IN THE RECIPIENT'S PARISH. IF RECIPIENTS DO NOT CHOOSE A PROVIDER BY THE DESIGNATED DATE THEY WILL BE AUTO-ASSIGNED BY THE STATE. PROVIDERS WHO ARE NOT ENROLLED AS A COMMUNITY CARE PROVIDER BY FEBRUARY 15, 2002
WILL NOT BE OFFERED AS A CHOICE. ANY MEDICAID PRIMARY CARE PROVIDER (FAMILY PRACTICE, GENERAL PRACTICE, INTERNAL MEDICINE, OB, PEDIATRICIAN) IN THE ABOVE LISTED PARISHES WHO WISHES TO ENROLL AS A COMMUNITYCARE PRIMARY CARE PROVIDER SHOULD BEGIN THE ENROLLMENT PROCESS NOW, IN ORDER TO BE INCLUDED AS AN AVAILABLE COMMUNITYCARE PROVIDER ON THE LETTERS WHICH RECIPIENTS WILL RECEIVE IN FEBRUARY. AFTER MARCH 1, 2002, PROVIDERS IN THESE PARISHES WHO DO NOT ENROLL IN COMMUNITYCARE WILL NEED TO OBTAIN A REFERRAL FROM THE COMMUNITYCARE PCP IN ORDER TO BILL FOR SERVICES TO MOST MEDICAID RECIPIENTS. ENROLLMENT PACKETS FOR COMMUNITYCARE MAY BE OBTAINED BY CONTACTING UNISYS PROVIDER RELATIONS AT 800-473-2783. QUESTIONS MAY BE DIRECTED TO PROVIDER RELATIONS AT THAT NUMBER, OR TO THE COMMUNITYCARE PROGRAM OFFICE AT 225-342-1304.

NOTICE TO CERTIFIED NURSE PRACTITIONERS

EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2001, THE FOLLOWING CPT CODE WILL BE ADDED TO THE LIST OF CODES PAYABLE TO CERTIFIED NURSE PRACTITIONERS. 31515 - LARYNGOSCOPY, WITH OR WITHOUT TRACHEOSCOPY; FOR ASPIRATION.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEE FOR CPT CODE J1055 (DEPO-PROVERA CONTRACEPTIVE INJECTION 150 MG/ML) WAS INCREASED TO $53.54 EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2001.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

CPT CODE 90508 (CATHETER PLACEMENT IN CORONARY ARTERY(S), ARTERIAL CORONARY CONDUIT(S), AND/OR VENOUS CORONARY BYPASS GRAFT(S) FOR CORONARY ANGIOGRAPHY WITHOUT CONCOMITANT LEFT HEART CATHETERIZATION) SHOULD BE INCLUDED IN THE PERFORMANCE OF CPT CODE 92980 (TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), PERCUTANEOUS, WITH OR WITHOUT OTHER THERAPEUTIC INTERVENTION, ANY METHOD; SINGLE VESSEL). THE ONLY TIME BOTH PROCEDURES MAY JUSTIFIABLY BE BILLED ON THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT IS WHEN THE PATIENT EXPERIENCES CHEST PAIN AFTER PLACEMENT AND THE POSSIBILITY EXISTS THAT THE STENT HAS CLOSED. IN THESE CASES, THE PROVIDER MUST REQUEST THE CLAIM BE RECONSIDERED FOR PAYMENT, 
AS EDITS WILL SOON BE PLACED IN THE SYSTEM TO DENY CODE 90508 IF THERE IS ALREADY A PAID CLAIM FOR CODE 92982, 92995, OR 92980 IN HISTORY FOR THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. LIKEWISE, A CLAIM FOR 92980, 92982, AND 92995 WILL DENY IF THERE IS A PAID 90508 IN HISTORY.