RA Messages for November 21, 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.

PLEASE MAKE THE FOLLOWING CHANGES TOT HE 5/15/00 VERSION OF APPENDIX C:

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEE FOR CPT CODE 47136(LIVER ALLOTRANSPLANTATION; HETEROTOPIC, PARTIAL OR WHOLE, FROM CADAVER OR LIVING DONOR, ANY AGE)HAS BEEN CHANGED TO $2, 122.12 EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000. 

NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

THE FOLLOWING INCREASE IN FEES HAS BEEN MADE EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000: 
CPT CODE 69400(EUSTACHIAN TUBE INFLATION,TRANSNASAL;WITH CATHETERIZATION) - $59.78 
CPT CODE 69401(EUSTACHIAN TUBE INFLATION,TRANSNASAL;WITHOUT CATHETERIZATION0 - $46.82 
CPT CODE 69405(EUSTACHIAN TUBE CATHETERIZATION, TRANSTYMPANIC) - $151.07

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

THE FEE FOR CPT CODE 96450 (CHEMOTHERAPY ADMINISTRATION, INTO CNS, REQUIRING AND INCLUDING LUMBAR PUNCTURE) HAS BEEN INCREASED FROM $32.90  TO $64.63 EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

TWO (2) BASE UNITS OF ANESTHESIA WERE FUNDED FOR CPT CODE 56441 (LYSIS OF LABIAL ADHESIONS) EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

WITH THE PUBLICATION OF THIS NOTICE, LOUISIANA MEDICAID IS CHANGING ITS POLICY ON THYROXINE(CPT CODE 84436) AND THYROID HORMONE (CPT CODE 84479) TO ALLOW FOR THE PAYMENT OF BOTH TESTS ON THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. 

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000, FOUR OTHER AUDITORY SYSTEM PROCEDURES (CODE 69200 - REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA, CODE 69205 - REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA, CODE 69210 - REMOVAL IMPACTED CERUMEN SEPARATE PROCEDURE; ONE OR BOTH EARS, AND CODE 69401 - EUSTACHIAN TUBE INFLATION, TRANSNASAL; WITHOUT CATHETERIZATION) WILL BE INCLUDED IN THE PERFORMANCE OF TYMPANOSTOMY (CPT CODE 69436).  THIS MEANS YOU WILL RECEIVE PAYMENT FOR ONLY CODE 69436 FOR A PARTICULAR RECIPIENT EVEN THOUGH THE OTHER FOUR PROCEDURES MAY BE PERFORMED ON THAT RECIPIENT AS WELL ON THE SAME DATE. CONVERSELY, A PAYMENT FOR CODE 69200 FOR A PARTICULAR RECIPIENT ON A PARTICULAR DATE OF SERVICE WILL RESULT  IN DENIALS OF CLAIMS FOR CODES 69205, 69210, 69401, AND 69436.

PROVIDERS WHO SUBMIT PROBLEM CLAIMS FOR RESEARCH AND A WRITTEN RESPONSE TO THE DHH TPL UNIT MUST SUBMIT A COVER LETTER EXPLAINING THE PROBLEM OR QUESTION, A COPY OF THE CLAIM(S), AND ALL PERTINENT DOCUMENTATION. CLAIMS RECEIVED WITHOUT A COVER LETTER WILL BE SENT DIRECTLY TO CLAIMS PROCESSING WITHOUT A REVIEW OF ANY KIND.