PHARMACY PROVIDERS, PLEASE NOTE!!! 

PLEASE MAKE THE FOLLOWING CHANGES TO APPENDIX A:  

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

ATTENTION PHARMACISTS AND PRESCRIBING PROVIDERS

EFFECTIVE NOVEMBER 22, 2005, THE LMPBM UNIT BEGAN REIMBURSING FOR SILDENAFIL (REVATIO) WHEN AN APPROPRIATE DIAGNOSIS CODE IS SUBMITTED ON THE POS CLAIM.  THE PRESCRIBING PROVIDER MUST DOCUMENT THE DIAGNOSIS CODE ON THE HARDCOPY PRESCRIPTION OR CAN COMMUNICATE THE DIAGNOSIS CODE OVER THE PHONE. THE ACCEPTABLE DIAGNOSIS CODES ARE:   

416.0-PRIMARY PULMONARY HYPERTENSION
416.8-OTHER CHRONIC PULMONARY HEART DISEASE                          

A DETAILED LETTER WILL FOLLOW IN THE MAIL. ALL NEW PRESCRIPTIONS FOR SYMBYAX (OLANZAPINE/FLUOXETINE) WILL REQUIRE AN APPROPRIATE ICD-9-CM DIAGNOSIS CODE WRITTEN ON THE HARDCOPY PRESCRIPTION AND BILLED THROUGH POS. THE ACCEPTED DIAGNOSIS CODES FALL IN THE RANGE FROM 290.0 THROUGH 319.9

ATTENTION PROVIDERS

PLEASE BE REMINDED THAT ROUTINE CIRCUMCISION CEASED TO BE A MEDICAID 
COVERED SERVICE EFFECTIVE APRIL 21, 2005. ANY MEDICAID PROVIDER RECEIVING PAYMENT FOR A ROUTINE CIRCUMCISION WITH A DATE OF SERVICE APRIL 21, 2005 FORWARD WILL BE SUBJECT TO RECOUPMENT.

AMBULATORY SURGERY GROUPS

EFFECTIVE FOR DATES OF SERVICE ON OR AFTER MARCH 1, 2005, THE LOUISIANA MEDICAID PROGRAM REQUIRED THE USE OF CPT/HCPC CODES FOR BILLING OUTPATIENT CLAIMS FOR AMBULATORY SURGICAL PROCEDURES. THE MEDICARE APPROVED AMBULATORY SURGICAL LIST OF PROCEDURES WAS UTILIZED. APPROXIMATELY 25,000 OUTPATIENT CLAIMS HAVE DENIED AS A RESULT OF THIS CHANGE. THE MAJORITY OF CLAIMS WHICH DENIED WERE BILLED WITH NO CPT/HCPC CODE. DHH HAS EVALUATED THOSE CODES REPORTED BY PROVIDERS THAT WERE NOT ON THE ORIGINAL LIST. A TOTAL OF 195 ADDITIONAL CODES HAVE BEEN ASSIGNED TO A GROUP, AND FOR THOSE PROVIDERS WHICH BILLED THESE CODES, YOU MUST RESUBMIT NEW CLAIMS FOR REIMBURSEMENT. WE WILL NOT REPROCESS THESE CLAIMS. 

AS WE TRANSITION THOSE CODES WHICH ARE NOT CONSIDERED AMBULATORY 
SURGERY, AND THEREFORE SHOULD NOT BE BILLED UNDER REVENUE CODE 490, MORE
SPECIFIC INSTRUCTION WILL BE PROVIDED AS TO THE APPROPRIATE METHOD OF 
BILLING. CPT/HCPC CODES BETWEEN THE RANGES OF 10021-69990, WILL CONTINUE TO BE EVALUATED AND PROVIDERS WILL BE MADE AWARE OF CHANGES AS THEY OCCUR. IT IS NO LONGER NECESSARY TO SUBMIT FOR REVIEW THOSE CODES WHICH ARE DENYING UNDER REVENUE CODE 490 WHICH FALL WITHIN THIS RANGE.

A COPY OF THE CODES WHICH HAVE BEEN EVALUATED WILL BE PUBLISHED ON THE 
DHH WEBSITE LOCATED AT WWW.DHH.LOUISIANA.GOV UNDER OFFICES, MEDICAID 
(HEALTH SERVICES FINANCING), RATE AND AUDIT REVIEW SECTION.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2005, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST AND CERTIFIED NURSE PRACTITIONER. 

93017          93018 

CLAIMS WITH DATES OF SERVICE THROUGH JULY 31, 2005, WILL BE PROCESSED UNDER THE "LIST" METHODOLOGY. 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. SEE THE MARCH/APRIL 2005 "LOUISIANA MEDICAID PROVIDER UPDATE" FOR ADDITIONAL INFORMATION. 

PHYSICIAN SUPPLIED/ADMINISTERED INJECTABLE ANTIBIOTICS

EFFECTIVE WITH DATES OF SERVICE DECEMBER 1, 2005 FORWARD, CPT CODE 90788 (IM INJECTION OF ANTIBIOTIC) WILL BE PLACED IN NON-PAY STATUS. FOR INJECTABLE ANTIBIOTICS SUPPLIED AND ADMINISTERED BY THE PHYSICIAN, PHYSICIANS ARE TO USE THE SPECIFIC HCPCS CODE WITH THE APPROPRIATE NUMBER OF UNITS. LOUISIANA MEDICAID'S REIMBURSEMENT FOR THESE HCPCS CODES IS BASED ON AVAILABLE 2005 LOUISIANA MEDICARE AVERAGE SALES PRICE (ASP) AMOUNTS. PROVIDERS ARE REFERRED TO THE PHYSICIAN FEE SCHEDULE ON WWW.LAMEDICAID.COM FOR UPDATED REIMBURSEMENT INFORMATION. 

PHYSICIAN ASSISTANT CLAIM ADJUSTMENTS

PRIOR TO THE IMPLEMENTATION OF THE 80% REIMBURSEMENT METHODOLOGY IN THE CLAIMS PROCESSING SYSTEM, SOME PHYSICIAN ASSISTANT CLAIMS PROCESSED INCORRECTLY, RESULTING IN OVERPAYMENTS. A 'SYSTEM' ADJUSTMENT OF THESE CLAIMS CAN BE FOUND ON THE REMITTANCE OF DECEMBER 6, 2005.