RA Messages for November 8, 2005
PHARMACY PROVIDERS, PLEASE NOTE!!!
PLEASE
MAKE THE FOLLOWING CHANGES TO APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| BRIMONIDINE TARTRATE |
SOL/DROPS,OPH |
0.2% |
$4.50000 |
11/12/05 |
| CEFUROXIME AXETIL |
TAB |
250MG |
$2.54250 |
11/12/05 |
| CEFUROXIME AXETIL |
TAB |
500MG |
$4.74750 |
11/12/05 |
| CILOSTAZOL |
TAB |
100MG |
$1.03880 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
25MG |
$0.05760 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
50MG |
$0.08280 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
75MG |
$1.03040 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
100MG |
$1.35390 |
11/12/05 |
| DESIPRAMINE HCL |
TAB |
150MG |
$1.96170 |
11/12/05 |
| FOLIC ACID |
TAB |
1MG |
$0.28580 |
11/12/05 |
| GENTAMICIN SULFATE |
TOP CR 15GM |
1% |
$0.20000 |
11/12/05 |
| GENTAMICIN SULFATE |
TOP OINT 15GM |
1% |
$0.20000 |
11/12/05 |
| METRONIDAZOLE |
TOP CR 45GM |
0.75% |
$1.62630 |
11/12/05 |
| MOMETASONE FUROATE |
TOP OINT 45GM |
0.1% |
$0.93330 |
11/12/05 |
| NYSTATIN |
TOP POWDER 15GM |
100,000U |
$1.74800 |
11/12/05 |
| OXYBUTYNIN CHLORIDE |
SYRUP 473ML |
5MG/ML |
$0.08250 |
11/12/05 |
| PHENYTOIN |
OR SUSP 237ML |
125MG/5ML |
$0.15210 |
11/12/05 |
| POTASSIUM CHLORIDE |
EXT REL TAB |
10MEQ |
$0.25380 |
11/12/05 |
| POTASSIUM CHLORIDE |
EXT REL TAB |
20MEQ |
$0.46250 |
11/12/05 |
| PYRIDOSTIGMINE BROMIDE |
TAB |
60MG |
$0.58320 |
11/12/05 |
| RIFAMPIN |
CAP |
300MG |
$1.88600 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
1MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
2MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
5MG |
$0.60000 |
11/12/05 |
| TERAZOSIN HCL |
CAP |
10MG |
$0.60000 |
11/12/05 |
| TORSEMIDE |
TAB |
100MG |
$2.91750 |
11/12/05 |
| TRIMETHPBENZAMIDE
HCL |
CAP |
300MG |
$1.01930 |
11/12/05 |
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG
PRODUCT, PLEASE CONTACT THE PBM HELP DESK AT 1-800-648-0790
PLEASE FILE ADJUSTMENTS FOR CLAIMS THAT MAY
HAVE BEEN INCORRECTLY PAID.
ONLY THOSE PRODUCTS OF THE MANUFACTURERS WHICH
PARTICIPATE IN THE FEDERAL
REBATE PROGRAM WILL BE COVERED BY THE MEDICAID PROGRAM. PARTICIPATION MAY BE
VERIFIED IN APPENDIX C, AVAILABLE AT WWW.LAMEDICAID.COM
IMPORTANT INFORMATION REGARDING COMMUNITYCARE
REFERRALS
EFFECTIVE WITH DATES OF SERVICE SEPTEMBER 21, 2005 - OCTOBER 31, 2005,
THE COMMUNITYCARE REFERRAL AND KIDMED LINKAGE REQUIREMENTS WILL BE WAIVED FOR RECIPIENTS FROM ALLEN, BEAUREGARD, EVANGELINE, LAFAYETTE,
VERNON, JEFFERSON DAVIS, ACADIA, AND ST. MARTIN PARISHES. THIS MEANS THAT COMMUNITYCARE SERVICES PROVIDED TO RECIPIENTS FROM THE ABOVE
PARISHES FOR DATES OF SERVICE SEPTEMBER 21, 2005 - OCTOBER 31, 2005 DO NOT REQUIRE A REFERRAL FROM THE PCP, AND KIDMED ENROLLEES WHO ARE NOT IN
COMMUNITYCARE CAN RECEIVE KIDMED SERVICES FROM ANY CERTIFIED LOUISIANA MEDICAID PROVIDER.IN ADDITION,THE SAME
COMMUNITYCARE/KIDMED REQUIREMENTS MENTIONED ABOVE WILL BE WAIVED FOR RECIPIENTS FROM
CALCASIEU, CAMERON, VERMILLION, IBERIA AND ST. MARY PARISHES FOR DATES OF SERVICE SEPTEMBER
21, 2005 UNTIL FURTHER NOTICE.
CHIROPRACTIC SERVICES CHANGE
PROCEDURE CODES 97260 AND 97261 HAVE BEEN DELETED IN THE 'CURRENT
PROCEDURAL TERMINOLOGY' MANUAL (CPT). EFFECTIVE WITH DATES OF SERVICE 9-1-05 FORWARD, CHIROPRACTORS SHOULD BILL FOR SERVICES USING THE CURRENT
APPROPRIATE CPT CODE (98940 OR 98941) FOR THE SERVICE PROVIDED. LOUISIANA MEDICAID'S NON-ENHANCED FEE FOR THESE CODES IS BASED ON 80% OF
THE 2005 MEDICARE ALLOWANCE. HCPCS MODIFIER 'AT' (ACUTE TREATMENT) MAY BE APPENDED. MEDICAID COVERAGE AND CRITERIA REGARDING THESE SERVICES HAS
NOT CHANGED. CLAIMS USING CPT CODES 97260 AND 97261 THAT DENY EFFECTIVE 9-1-05 SHOULD BE RESUBMITTED USING CURRENT CODES.
PHYSICIAN ASSISTANT CLAIMS
EFFECTIVE IMMEDIATELY, PROVIDERS MAY SUBMIT CLAIMS FOR SERVICES
PERFORMED BY PHYSICIAN ASSISTANTS (PA) FOR DATES OF SERVICE JULY 1, 2005 FORWARD. THIS INCLUDES CLAIMS THAT HAVE BEEN HELD AWAITING THIS
IMPLEMENTATION. MEDICAID REQUIRES THAT PA'S ENROLL AND ALL SERVICES THEY PROVIDE BE BILLED IDENTIFYING THE PA AS THE ATTENDING PROVIDER. SEE THE
MARCH/APRIL 2005 "LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION.
CERTIFIED NURSE PRACTITIONER, CLINICAL NURSE
SPECIALIST
AND CERTIFIED NURSE MIDWIFE CLAIMS
EFFECTIVE IMMEDIATELY, PROVIDERS MAY SUBMIT CLAIMS FOR SERVICES PERFORMED
BY CNP'S, CNS'S AND CNM'S FOR DATES OF SERVICE AUGUST 1, 2005 FORWARD. THIS INCLUDES THOSE CLAIMS THAT HAVE BEEN HELD AWAITING THIS
NOTIFICATION. MEDICAID IMPLEMENTED CHANGES IN REIMBURSEMENT METHODOLOGY FROM A "LIST" OF BILLABLE SERVICES, TO COVERAGE DETERMINED BY LICENSURE
AND SCOPE OF PRACTICE, EFFECTIVE WITH DATE OF SERVICE AUGUST 1, 2005. MEDICAID REQUIRES THAT ALL SERVICES PERFORMED BY THESE PROVIDERS BE
BILLED IDENTIFYING THE CNP, CNS, OR CNM AS THE ATTENDING PROVIDER. SEE THE MARCH/APRIL 2005
"LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION.