RA Messages for December 23, 2008

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 NOTE THE FOLLOWING CHANGES TO APPENDIX A

         DRUG                                         DOSE             STRGTH             FUL             LMAC                 EFF
CLORAZEPATE DIPOTASS             TABLET            7.5MG          $0.19470                                  11/28/08
MORPHINE SULFATE                   SOLUTION        20MG/ML                             OFF MAC         12/02/08

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. 

PEDIATRIC CRITICAL CARE PATIENT TRANSPORT

Effective with date of service January 1, 2008 forward, Louisiana Medicaid reimburses CPT codes 99289 and 99290 (Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less;...). Policy regarding these services can be found on the Medicaid website homepage, www.lamedicaid.com, and via the link there to "New Medicaid Information".

ATTENTION PROVIDERS OF IMMUNIZATIONS

Effective with date of service August 6, 2008, reimbursement rates for select immunization administration codes (90465, 90467, 90471, and 90473) have been updated utilizing the same reimbursement methodology as used for the Professional Services 2008 reimbursement rate changes. However, the updated immunization administration rates cannot exceed the maximum regional charge, currently $15.22, as determined by CMS. This rate is used where applicable. The updated rates can be found on the Immunization Fee Schedules located on the Medicaid website, www.lamedicaid.com, following the Fee Schedules link. Affected claims paid at the previous rate will be systematically adjusted in the near future and no action will be required by providers. Please monitor your RA's for the specific date(s) the adjustments will take place.

ALL PROVIDERS WITH PART A CROSSOVER CLAIMS

We have recently become aware that not all of the Medicare Part A Crossover claims were processed for the month of November. These claims have been identified and will be processed in the RA's of 12/16/08 and/or 12/23/08. If you believe you have outstanding Part A claims after the aforementioned RA's have been received, you will need to submit them hardcopy with Medicare EOMB attached.

IMMUNIZATION PAY-FOR-PERFORMANCE INITIATIVE

A slide presentation with detailed information on Louisiana Medicaid's CommunityCARE Immunization Pay-for-Performance Initiative has been placed on the LA Medicaid website (www.lamedicaid.com) following the link for Pay-for-Performance in the directory on the home page. Providers that administer immunizations to Medicaid enrolled children are encouraged to review this material online.

ATTENTION: PROVIDERS ADMINISTERING IMMUNIZATIONS

LA Medicaid has placed three vaccine CPT procedure codes in non-payable status for Medicaid recipients. These vaccines are no longer available from VFC as they are no longer acceptable for use in the United States. The two components affected are DTP, which has been replaced with DTaP, and OPV, as oral polio vaccine is no longer used in the US. The non-payable codes are: 90701, 90712, and 90720. Please review the online Immunization Fee Schedule at www.lamedicaid.com for acceptable vaccine codes and ensure that you are using the correct procedure code for the vaccine administered.

ATTENTION HOSPITAL PROVIDERS

We continue to receive questions from providers concerning the 2007 policy clarification related to billing ONLY ONE revenue code 450 for out-patient emergency room visits and the recent RA message related to this subject indicating that denial edits are now in place to prevent billing multiple 450-459 revenue codes in these circumstances. We understand that Medicare and other payers allow billing multiple 450-459 codes in certain circumstances, however, this is NOT LA Medicaid policy.

The appropriate level of ER visit code should be billed on your outpatient claim form, and the services performed MAY NOT be billed separately under other 450-459 codes or any other revenue codes. The appropriate HCPC designating the applicable level of ER visit (99281-99285) is the only allowed HCPC.

Claims should include all other appropriate revenue codes (i.e. pharmacy, lab, x-rays and supplies) which were utilized in the patient's treatment, using the appropriate revenue code and procedure code/HCPC if applicable.

Hospitals should establish a charge/fee for EACH level of emergency room visit (99281-99285). That charge/fee is all-inclusive for whatever services are being performed in the emergency room/department (i.e. use of room, injections, infusions, suturing, casting, etc.) Any non-ambulatory surgical (HR490) services performed in the ER such as the application of splints, injections, suturing, etc. are built into the reimbursement paid to the hospital under one of the 5 ER visit codes depending on the level of complexity of the ER visit.