RA Messages for December 30, 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
ACEBUTOLOL HCL
CAPSULE
200MG $0.4613 01/12/09
ACEBUTOLOL HCL
CAPSULE
400MG $0.6713 01/12/09
AMITRIPTYLINE
TABLET
50MG $0.0758 01/12/09
AMITRIPTYLINE
TABLET
100MG $0.1568 01/12/09
AMOXICILLIN
CAPSULE
250MG $0.0653 01/12/09
AMOXICILLIN
CAPSULE
500MG $0.1193 01/12/09
AMOXICILLIN TRIHYDRATE SUSP REC
125MG/5ML $0.0201
01/12/09
AMOXICILLIN TRIHYDRATE SUSP REC
250MG/5ML $0.0299
01/12/09
ATENOLOL/CHLORTHALIDON TABLET
50MG/25MG $0.1122
01/12/09
ATENOLOL/CHLORTHALIDON TABLET
100MG/25MG $0.3068
01/12/09
BUSPIRONE HCL
TABLET
5MG $0.0527 01/12/09
BUSPIRONE HCL
TABLET
10MG $0.0714
01/12/09
BUSPIRONE HCL
TABLET
15MG $0.1028 01/12/09
CARBIDOPA/LEVODOPA
TABLET 10MG/100MG
$0.4043 01/12/09
CARBIDOPA/LEVODOPA
TABLET 25MG/100MG
$0.4688 01/12/09
CARISOPRODOL
TABLET
350MG $0.0851 01/12/09
CEFUROXIME AXETIL TABLET
250MG $0.5513
01/12/09
CEFUROXIME AXETIL TABLET
500MG $1.0665
01/12/09
CLOMIPRAMINE HCL CAPSULE
25MG $0.3750 01/12/09
CLOMIPRAMINE HCL CAPSULE
50MG $0.5036
01/12/09
CLONAZEPAM TABLET
0.5MG $0.0600 01/12/09
CLONAZEPAM TABLET
1MG $0.0780
01/12/09
CLONAZEPAM TABLET
2MG $0.1080
01/12/09
CLONIDINE HCL TABLET
0.1MG $0.1050 01/12/09
CLONIDINE HCL TABLET
0.2MG $0.1410 01/12/09
CLONIDINE HCL TABLET
0.3MG $0.1815
01/12/09
FLUOXIDINE HCL CAPSULE
10MG $0.1386 01/12/09
FLUOXIDINE HCL CAPSULE 20MG $0.1454 01/12/09
FLUOXIDINE HCL CAPSULE 40MG $1.1625 01/12/09
FLUOXIDINE HCL SOLUTION 20MG/5ML $0.2250 01/12/09
GUANFACINE HCL TABLET 1MG $0.1242 01/12/09
GUANFACINE HCL TABLET 2MG $0.7011 01/12/09
HYDROCORTISONE CREAM,TOPICAL 1% $0.0560 01/12/09
HYDROCORTISONE CREAM,TOPICAL 2.5% $0.1650 01/12/09
HYDROCORTISONE LOTION,TOPIC 2.5% $0.7500 01/12/09
HYDROXYZINE HCL SYRUP 10MG/5ML OFF MAC 01/12/09
IBUPROFEN TABLET 400MG $0.0345 01/12/09
IBUPROFEN TABLET 600MG $0.0417 01/12/09
IBUPROFEN TABLET 800MG $0.0638 01/12/09
LOVASTATIN TABLET 10MG $0.3285 01/12/09
LOVASTATIN TABLET 20MG $0.4622 01/12/09
LOVASTATIN TABLET 40MG $0.7922 01/12/09
MORPHINE SULFATE SOLUTION 20MG/ML OFF MAC 12/02/08
NYSTATIN CREAM,TOPIC 100MU/GM $0.0990 01/12/09
OXYBUTYNIN CHLORIDE SYRUP 5MG/5ML $0.0278 01/12/09
OXYBUTYNIN CHLORIDE TABLET 5MG $0.1650 01/12/09
SILVER SULFADIZINE CREAM,TOPIC 1% $0.0628 01/12/09
SULFACETAMIDE SODIUM SOL/DROPS,OPH 10% $0.1690 01/12/09
TERAZOSIN HCL CAPSULE 1MG $0.1425 01/12/09
TERAZOSIN HCL CAPSULE 2MG $0.1425 01/12/09
TERAZOSIN HCL CAPSULE 5MG $0.1425 01/12/09
TERAZOSIN HCL CAPSULE 10MG $0.1425 01/12/09
VERAPAMIL HCL TABLET 80MG $0.0773 01/12/09
VERAPAMIL HCL TABLET 120MG $0.1148 01/12/09
ZIDOVUDINE TABLET 300MG $0.9110 01/12/09
ZONISAMIDE CAPSULE 25MG $0.1031 01/12/09
ZONISAMIDE CAPSULE 50MG $0.2112 01/12/09
ZONISAMIDE CAPSULE 100MG $0.4998 01/12/09
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.
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.
ATTENTION ALL PROVIDERS
2009 HCPCS UPDATE
Louisiana Medicaid is in the process of completing the
programming for
the 2009 HCPCS updates. This includes both new and deleted codes for
2009. Every attempt is being made to have the new codes/updates on file
by mid January 2009. Please note that all appropriate editing and coverage determinations for the new codes may not be final at that time and
adjustments to claims processed may be necessary. Providers should
monitor future RA messages.
ALL PROVIDERS
The Louisiana Legislature has funded additional New Opportunity Waiver
slots through the NOW Trust Fund. Most New Opportunity Waiver slots
filled on or after November 3, 2008 are part of the NOW Trust Fund. A
system for processing claims for recipients of this group is currently
in development. Claims for any Medicaid services provided for NOW Trust
Fund recipients of waiver slots will not be accepted until after
January 1, 2009. At that time, all claims for these recipients will be
held as "pending" with a tentative payment begin date of February 1,
2009. However, providers will be notified as soon as programming is
completed, and payment of the pending claims will move forward for final
processing at that time.