RA Messages for January 2, 2001

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:

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.

NOTICE TO ONCOLOGISTS

DOCETAXEL (TAXOTERE), CPT CODE J9170, HAS BEEN FUNDED EFFECTIVE WITH DATE OF SERVICE JUNE 1, 2000 WITH A FEE OF $253.72 PER 20 MG. EFFECTIVE WITH DATE OF SERVICE NOVEMBER 1, 2000, THE FEE WAS INCREASED TO $266.48.  THE PRIMARY DIAGNOSES FOR WHICH THIS AGENT WILL BE REIMBURSED ARE 162.0  THRU 162.9, 174.0 THRU 174.9, 175.0 THRU 175.9, 198.1, 231.2, AND 233.0.

NOTICE TO ONCOLOGISTS

DENILEUKIN DIFITOX (ONTAK), CPT CODE J9160, HAS BEEN FUNDED EFFECTIVE WITH DATE OF SERVICE JANUARY 1, 2001 FOR THE TREATMENT OF PERSISTENT OR RECURRENT CUTANEOUS T-CELL LYMPHOMA WITH A FEE OF $894.63 PER 2 ML VIAL. THE PRIMARY DIAGNOSES FOR WHICH THIS AGENT WILL BE REIMBURSED ARE 202.1 OR 202.2.