RA Messages for January 6, 2004
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 FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
ATTENTION PHARMACY PROVIDERS
THE DEPARTMENT HAS RECENTLY ADDED DRUG COVERAGE FOR LEVITRA AND CIALIS.
PLEASE BE ADVISED THAT THE POLICY FOR MEDICATIONS USED IN THE TREATMENT OF
ERECTILE DYSFUNCTION APPLIES FOR THESE NEW PRODUCTS, INCLUDING A
MAXIMUM OF SIX (6) UNITS PER CALENDAR MONTH. PRESCRIPTIONS USED IN THE
TREATMENT OF ERECTILE DYSFUNCTION MUST BE HAND WRITTEN AND SHALL INCLUDE A
MEDICAL DIAGNOSIS CLINICALLY APPROPRIATE TO THE TREATMENT WHICH IS TO BE WRITTEN
ON THE HARD COPY PRESCRIPTION OR A PRESCRIBER SIGNED
ND DATED ATTACHMENT TO THE PRESCRIPTION.
THE FOLLOWING DIAGNOSIS CODES ARE ACCEPTABLE:
| ICD-9 CODE |
DESCRIPTION |
| 302.72 |
IMPOTENCE OF NON-ORGANIC ORIGIN |
| 607.84 |
IMPOTENCE OF ORGANIC ORIGIN |
THE DEPARTMENT ALLOWS NO STIPULATION FOR OVERRIDE OF EARLY REFILL,
DUPLICATE DRUG THERAPY OR THERAPEUTIC DUPLICATION DENIALS FOR ERECTILE DYSFUNCTION
PRESCRIPTION MEDICATIONS.
HOME AND COMMUNITY-BASED WAIVER SERVICES
FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
EFFECTIVE WITH DATE OF SERVICE JULY 1, 2003, HCPCS CODE G0202
FOR SCREENING MAMMOGRAPHY WAS MADE PAYABLE AT A FEE OF $121.73. THIS CODE
IS RESTRICTED TO CROSSOVERS.