RA Messages for March 25, 2003
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 1/01/02 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF DATE |
| ALBUTEROL |
AEROSOL |
90MCG |
$0.88230 |
03/11/03 |
| AMITRIPTYLINE HCL |
TAB |
10MG |
$0.06080 |
03/11/03 |
| AMITRIPTYLINE HCL |
TAB |
25MG |
$0.06530 |
03/11/03 |
| AMITRIPTYLINE HCL |
TAB |
75MG |
$0.14250 |
03/11/03 |
| CAPTOPRIL/HCTZ |
TAB |
25-25MG |
$0.23600 |
03/11/03 |
| CEFADROXIL MONOHYDRATE |
CAP |
500MG |
$2.48370 |
03/11/03 |
| CLONIDINE HCL |
TAB |
0.1MG |
$0.09680 |
03/11/03 |
| CLONIDINE HCL |
TAB |
0.3MG |
$0.17940 |
03/11/03 |
| CLONIDINE HCL |
TAB |
0.2MG |
$0.13500 |
03/11/03 |
| DESOXIMETASONE 60GM |
CREAM |
0.25% |
$0.61800 |
03/11/03 |
| DEXAMETHASONE |
ELIXIR |
0.5MG/5ML |
$0.06250 |
03/11/03 |
| FOLIC ACID |
TAB |
1MG |
$0.04650 |
03/11/03 |
| FUROSEMIDE |
TAB |
80MG |
$0.10430 |
03/11/03 |
| GEMFIBROZIL |
TAB |
600MG |
$0.26850 |
03/11/03 |
| GLYBURIDE |
TAB |
1.25MG |
$0.12440 |
03/11/03 |
| GLYBURIDE |
TAB |
2.5MG |
$0.18930 |
03/11/03 |
| GLYBURIDE |
TAB |
5MG |
$0.28310 |
03/11/03 |
| HYDRALAZINE HCL |
TAB |
25MG |
$0.05190 |
03/11/03 |
| HYDROCORTISONE 120ML |
LOTION |
1% |
$0.05720 |
03/11/03 |
| HYDROXYZINE PAMOATE |
CAP |
25MG |
$0.08920 |
03/11/03 |
| IMIPRAMINE HCL |
TAB |
10MG |
$0.32100 |
03/11/03 |
| IMIPRAMINE HCL |
TAB |
25MG |
$0.42750 |
03/11/03 |
| IMIPRAMINE HCL |
TAB |
50MG |
$0.56150 |
03/11/03 |
| LISINOPRIL |
TAB |
2.5MG |
$0.38550 |
03/11/03 |
| LISINOPRIL |
TAB |
5MG |
$0.57830 |
03/11/03 |
| LISINOPRIL |
TAB |
10MG |
$0.59700 |
03/11/03 |
| LISINOPRIL |
TAB |
20MG |
$0.63900 |
03/11/03 |
| LISINOPRIL |
TAB |
30MG |
$0.90380 |
03/11/03 |
| LISINOPRIL |
TAB |
40MG |
$0.93450 |
03/11/03 |
| LISINOPRIL/HCTZ |
TAB |
10-12.5MG |
$0.64500 |
03/11/03 |
| LISINOPRIL/HCTZ |
TAB |
20-12.5MG |
$0.69830 |
03/11/03 |
| LISINOPRIL/HCTZ |
TAB |
20-25MG |
$0.70650 |
03/11/03 |
| METHYLPREDNISOLONE |
TAB |
4MG |
$0.28490 |
03/11/03 |
| METRONIDAZOLE |
TAB |
250MG |
$0.08490 |
03/11/03 |
| NAPROXEN |
TAB |
500MG |
$0.18050 |
03/11/03 |
| NIZATIDINE |
CAP |
150MG |
$1.83070 |
03/11/03 |
| NIZATIDINE |
CAP |
300MG |
$3.66150 |
03/11/03 |
| OXAZEPAM |
CAP |
30MG |
$1.23085 |
03/11/03 |
| PENICILLIN V POTASSIUM 200ML |
SUSP |
250MG/5ML |
$0.02535 |
03/11/03 |
| PREDNISONE |
TAB |
5MG |
$0.06405 |
03/11/03 |
| PREDNISONE |
TAB |
10MG |
$0.06760 |
03/11/03 |
| PREDNISONE |
TAB |
20MG |
$0.11770 |
03/11/03 |
| PROPRANOLOL HCL/HCTZ |
TAB |
40-25MG |
$0.08770 |
03/11/03 |
| PROPRANOLOL HCL/HCTZ |
TAB |
80-25MG |
$0.13200 |
03/11/03 |
| QUINIDINE GLUCONATE |
TAB SA |
324MG |
$0.50550 |
03/11/03 |
| SULINDAC |
TAB |
150MG |
$0.33170 |
03/11/03 |
| SULINDAC |
TAB |
200MG |
$0.42890 |
03/11/03 |
| THEOPHYLLINE ANHYDROUS |
TAB |
300MG |
$0.30020 |
03/11/03 |
| THIORIDAZINE HCL |
TAB |
10MG |
$0.21900 |
03/11/03 |
| THIORIDAZINE HCL |
TAB |
25MG |
$0.30300 |
03/11/03 |
| THIORIDAZINE HCL |
TAB |
100MG |
$0.50250 |
03/11/03 |
| THIOTHIXENE |
CAP |
1MG |
$0.13880 |
03/11/03 |
| TIZANIDINE |
TAB |
2MG |
$0.80710 |
03/11/03 |
| TIZANIDINE |
TAB |
4MG |
$0.95600 |
03/11/03 |
| TRAMADOL |
TAB |
50MG |
$0.30680 |
03/11/03 |
| TRIAMCINOLONE ACETONIDE |
PASTE |
0.1% |
$1.87800 |
03/11/03 |
| TRIAMCINOLONE ACETONIDE 60ML |
LOTION |
0.1% |
$0.17033 |
03/11/03 |
| VALPROIC ACID |
CAP |
250MG |
$0.34880 |
03/11/03 |
| VERAPAMIL HCL |
TAB |
80MG |
$0.07350 |
03/11/03 |
| VERAPAMIL HCL |
TAB |
120MG |
$0.11100 |
03/11/03 |
| VERAPAMIL HCL |
TAB |
240MG |
$0.36830 |
03/11/03 |
PLEASE FILE
ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION ALL PROVIDERS
THE PROVIDER ENROLLMENT UNIT HAS A NEW PHONE NUMBER. IT IS
225-237-3370.
ATTENTION 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
CPT CODE 51736(SIMPLE UROFLOWMETRY) WILL BE MADE PAYABLE
EFFECTIVE WITH DATE OF SERVICE MARCH 1, 2003 AT A FEE OF $31.06. THE
PROFESSIONAL COMPONENT FEE WILL BE $15.53.
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
THE FEE FOR CPT CODE 53850 (TRANSURETHRAL DESTRUCTION OF
PROSTATE TISSUE BY MICROWAVE THERMO THERAPY) WILL BE INCREASED TO $1,522.20
EFFECTIVE WITH DATE OF SERVICE MARCH 1, 2003.