RA Messages for December 26, 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
12/9/00 VERSION OF
APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| ALBUTEROL |
AEROSOL |
90MCG |
1.26470 |
12/07/00 |
| ALBUTEROL |
AER REF |
90MCG |
1.16970 |
12/07/00
|
| ALBUTEROL SULFATE |
SOL |
5MG/ML |
0.33300 |
12/07/00 |
| CEFACLOR |
SUSP RECON |
187MG/5ML
75ML |
OFF MAC |
12/07/00 |
| CIMETIDINE |
HCL LIQ |
39MG.5ML 240ML |
0.11400 |
12/07/00 |
| DEXAMETHASONE |
ELIX |
240 ML |
0.04000 |
12/07/00 |
| DEXAMETHASONE |
ELIX |
ALL OTH SIZ |
0.06603 |
12/07/00 |
| DEXAMETHASONE |
TAB |
0.5MG |
0.09750 |
10/31/99 |
| HALOPERIDOL |
TAB |
5MG (CHG AGAIN) |
0.57000 |
12/07/00 |
| HYDRALAZINE |
TAB |
50 MG |
OFF MAC |
12/07/00 |
| HYDROCODONE BITARTR/APAP |
TAB |
2.5-500 MG |
OFF MAC |
12/07/00 |
| LEUCOVORIN CALCIUM |
TAB |
25MG |
OFF MAC |
12/07/00 |
| LINDANE |
LOT |
1% ALL OTH SIZ |
OFF MAC |
10/14/99 |
| LINDANE |
SHAMPOO |
1% |
0.16000 |
12/07/00 |
| MECLIZINE HCL |
TAB |
12.5MG |
0.03700 |
12/07/00 |
| METHYLDONE HCL |
ORAL CONC |
10MG/ML |
OFF MAC |
12/07/00 |
| NADOLOL |
TAB |
80MG |
OFF MAC |
12/07/00 |
| PREDNISONE SOD PHOS |
SOL |
1% 5ML |
1.92000 |
12/07/00 |
| TOLBUTAMIDE |
TAB |
500MG |
OFF MAC |
12/07/00 |
| TRIAMCINOLONE ACET |
OINT |
0.025% 15GM |
0.08933 |
12/07/00 |
| VERAAPAMIL |
TAB SA |
120MG |
OFF MAC |
12/07/00 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
NOTICE TO PROVIDERS
THE MEDICAID DIAGNOSIS FILE UPDATE HAS BEEN COMPLETED EFFECTIVE WITH DATE OF SERVICE 10/1/2000. PROVIDERS MAY BEGIN BILLING WITH 2001
DIAGNOSIS CODES FOR DATES OF SERVICE 10/1/2000 AND AFTER.
NOTICE TO PROFESSIONAL SERVICE PROVIDERS
CURRENTLY, TWO CODES FOR DEPO-PROVERA, J9162 AND J1055, ARE IN PAYMENT STATUS ON OUR FILE. EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2000, CPT CODE J9162 WILL BE PLACED IN NON-PAY STATUS, AS IT NO LONGER APPEARS ON
THE MEDICARE DRUG INJECTION LIST. CODE WILL REMAIN PAYABLE FOR DEPO-PROVERA INJECTIONS.
DENTAL PROVIDERS
CLARIFICATION REGARDING ORTHODONTIC SERVICES - EPSDT DENTAL PROGRAM THE LIMITATIONS FOR ORTHODONTIC SERVICES COVERED UNDER THE MEDICAID EPSDT DENTAL PROGRAM HAVE NOT CHANGED. THE POLICY AS STATED IN THE DENTAL SERVICES MANUAL, PAGES 4-16 AND 4-17, IS ACCURATE. ORTHODONTIC TREATMENT IS PROVIDED ONLY IN THOSE INSTANCES IN WHICH TREATMENT IS CONSIDERED MEDICALLY NECESSARY (I.E.,CLEFT PALATE AND/OR LIP, CROUZON'S SYNDROME,
TREACHER-COLLINS SYNDROME, PIERRE-ROBIN SYNDROME, HEMI-FACIAL ATROPHY, HEMI-FACIAL HYPERTROPHY, AND OTHER CRANIOFACIAL DEFORMITIES, RESULTING IN A PHYSICALLY HANDICAPPING MALOCCLUSION.) PATIENTS HAVING ONLY CROWDED DENTITION, EXCESSIVE OVERBITE AND/OR OVERJET ARE NOT COVERED. THE CORRECTION OF ISOLATED CROSSBITES MAY BE CONSIDERED, IF THE
SERVICES CAN BE PERFORMED IN THEIR ENTIRETY FOR $200 OR LESS. ALL ORTHODONTIC REQUESTS REQUIRE PRIOR AUTHORIZATION. IF THE DENTAL PROVIDER
DETERMINES THAT THE EPSDT RECIPIENT COULD POSSIBLY MEET THE SPECIFIED CRITERIA, THE PROVIDER SHOULD REFER THE RECIPIENT TO A PARTICIPATING MEDICAID ORTHODONTIST OR IF REFERRAL ASSISTANCE IS REQUIRED, THE PROVIDER SHOULD REFER THE RECIPIENT TO THE KIDMED AND COMMUNITY CARE REFERRAL ASSISTANCE HOTLINE AT 1-877-455-9955. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS MATTER, YOU MAY CONTACT THE LSU SCHOOL OF DENTISTRY, DENTAL MEDICAID UNIT BY CALLING 504-619-8589.