RA Messages for March 2, 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.
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF DATE |
| ACETAMINOPHEN/CAFF/BUTALB |
TAB |
500-40-50 |
0.53990 |
03/20/04 |
| ALBUTEROL SULFATE |
TAB |
4MG |
0.14250 |
03/20/04 |
| AMOXICILLIN TRIHYDRATE |
SUS RECON |
250MG/5ML |
0.02810 |
03/20/04 |
| BISOPROL/HYDROCHLOROTHIAZIDE |
TAB |
10-6.25MG |
OFF MAC |
03/20/04 |
| CARBIDOPA/LEVODOPA |
TAB |
25-100MG |
0.44550 |
03/20/04 |
| CARBIDOPA/LEVODOPA |
TAB |
25-250MG |
0.51450 |
03/20/04 |
| CHLORTHALIDONE |
TAB |
25MG |
0.17540 |
03/20/04 |
| CHLORTHALIDONE |
TAB |
50MG |
0.17500 |
03/20/04 |
| CLONIDINE HCL |
TAB |
0.3MG |
0.18300 |
03/20/04 |
| DOXYCYCLINE HYCLATE |
CAP |
50MG |
0.09450 |
03/20/04 |
| DOXYCYCLINE HYCLATE |
CAP |
100MG |
0.12150 |
03/20/04 |
| ERYTHROMYCIN BASE |
CAP DR |
250MG |
0.15380 |
03/20/04 |
| GEMFIBROZIL |
TAB |
600MG |
0.38000 |
03/20/04 |
| HYDROCODONE BIT/ACETAMINOPHEN |
TAB |
25-500MG |
0.21900 |
03/20/04 |
| HYDROXYZINE HCL |
TAB |
25MG |
0.71340 |
03/20/04 |
| ISOSORBIDE DINITRATE |
TAB |
5MG |
0.01980 |
03/20/04 |
| ISOSORBIDE DINITRATE |
TAB |
10MG |
0.02050 |
03/20/04 |
| ISOSORBIDE DINITRATE |
TAB |
20MG |
0.37500 |
03/20/04 |
| METFORMIN HCL |
TAB |
500MG |
0.35570 |
03/20/04 |
| METFORMIN HCL |
TAB |
850MG |
0.38630 |
03/20/04 |
| METHOCARBAMOL |
TAB |
500MG |
0.14250 |
03/20/04 |
| METHOCARBAMOL |
TAB |
750MG |
0.17920 |
03/20/04 |
| ORPHENADRINE CITRATE |
TAB SA |
100MG |
OFF MAC |
03/20/04 |
| PRIMIDONE |
TAB |
250MG |
0.69560 |
03/20/04 |
| PROMETHAZINE HCL |
SYRUP |
6.25MG/5ML |
0.01361 |
03/20/04 |
| PROPAFENONE HCL |
TAB |
150MG |
1.10490 |
03/20/04 |
| PROPAFENONE HCL |
TAB |
225MG |
1.56240 |
03/20/04 |
| TRAZODONE HCL |
TAB |
50MG |
0.74200 |
03/20/04 |
| TRAZODONE HCL |
TAB |
100MG |
0.11400 |
03/20/04 |
| TRIAMCINOLONE ACETONIDE |
CR |
0.5% |
0.23700 |
03/20/04 |
| TRIFLUOROPERAZINE HCL |
TAB |
5MG |
1.00980 |
03/20/04 |
| VERAPAMIL |
TAB SA |
180MG |
0.48380 |
03/20/04 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/01/02 VERSION OR
APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 00209 |
MARSAM |
|
04/01/04 |
| 11584 |
INTERNATIONAL ETHICAL LAB |
|
04/01/04 |
| 12463 |
ABANA PHARMACEUTICALS, INC |
|
04/01/04 |
| 17270 |
ARMSTRONG PHARMACEUTICALS |
04/01/04 |
|
| 54002 |
HYPERION MEDICAL, INC |
|
04/01/04 |
| 61703 |
FAULDING PHARMACEUTICAL COMPANY |
|
04/01/04 |
| 64054 |
AM2PAT, INC |
01/01/04 |
|
| 64679 |
WOCKHARDT AMERICAS |
04/01/04 |
|
| 65893 |
CODY LABORATORIES, INC |
|
04/01/04 |
| 67000 |
VERUM PHARMACEUTICALS, INC |
|
04/01/04 |
| 67402 |
SKIN MEDICA |
04/01/04 |
|
| 67555 |
PRONOVA CORPORATION |
04/01/04 |
|
| 67754 |
HARVEST PHARMACEUTICALS, INC |
04/01/04 |
|
| 68308 |
MIDLOTHIAN LABORATORIES |
04/01/04 |
|
| 68543 |
VICTORY PHARMA, INC |
04/01/04 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN
INCORRECTLY PAID.
NOTICE TO PHARMACIES AND PRESCRIBERS
UPDATED VERSIONS OF DRUG APPENDICES ARE NOW APPEARING ON THE
WEB-SITE. THESE WILL BE REFRESHED MONTHLY. NOTICE THE DATES AT THE TOP OF EACH
PAGE.
ATTENTION DME PROVIDERS
PROCEDURE CODE A4624 AND L8499 ARE BEING PLACED IN NON-PAY STATUS. WE
HAVE IDENTIFIED VALID, HIPAA COMPLIANT PROCEDURE CODES THAT ARE MORE APPROPRIATE AND HAVE BEEN MADE PAYABLE EFFECTIVE WITH DATES OF SERVICE
JANUARY 1, 2004 AND AFTER. PROVIDERS SHOULD BEGIN USING THE FOLLOWING CODES IMMEDIATELY, AS APPROPRIATE: A4609 - TRACHEAL SUCTION CATHETER/
LESS THAN 72 HOURS USE IN CLOSED SYSTEM ($10.01/CATHETER); A4610 - TRACHEAL SUCTION CATHETER/ANY TYPE OTHER THAN CLOSED SYSTEM ($1.76/
CATHETER); L8040 - NASAL PROSTHESIS ($1,352.99/INITIAL FITTING OR $1,285.34/REPLACEMENT INCLUDING NEW
IMPRESSION/MOULAGE OR $541.18/ REPLACEMENT USING PREVIOUS MASTER MODEL); L8041 - MIDFACIAL PROSTHESIS
($1,630.81/INITIAL FITTING OR $1,549.26/REPLACEMENT INCLUDING NEW IMPRESSION/MOULAGE OR $541.18/REPLACEMENT USING PREVIOUS MASTER MODEL);
L8042 - ORBITAL PROSTHESIS ($1,832.37/INITIAL FITTING OR $1,740.75/ REPLACEMENT INCLUDING NEW IMPRESSION/MOULAGE OR $732.95/REPLACEMENT
USING A PREVIOUS MASTER MODEL).
NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES
CPT CODE 92065 (ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH
CONTINUING MEDICAL DIRECTION AND EVALUATION) CAN ONLY BE BILLED IF THE PLACE OF
SERVICE (POS=11) IS THE PHYSICIAN'S OPTOMETRIST'S OFFICE AND PERFORMED 1 ON 1
WITH THE PATIENT.