RA Messages for April 9, 2002

 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 1/1/02 VERSION OF APPNEDIX A: 

DRUG DOSAGE  STRGTH MAC  EFF DATE
METHYLPREDNISOLONE ACE VIAL 80MG/ML OFF MAC 03/01/02 
NORETHINDRONE-ETHINYL EST TABLET 1-0.35MG 28'S OFF MAC 03/01/02 
PROCAINAMIDE HCL TABLET SA 750MG OFF MAC 03/01/02 

PLEASE MAKE THE FOLLOWING CHANGES TO THE 1/1/02 VERSION OF APPENDIX C:

LABELER               COMPANY BEGIN END
08367 RX HOLDINGS, LLC (DBA RXELITE) 07/01/02   
66794 RX HOLDINGS, LLC (DBA RXELITE) 07/01/02    
66870 AMBI PHARMACEUTICALS, INC.  07/01/02    

 PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID

ATTENTION COMMUNITY CARE PROVIDERS

THE FOLLOWING INCREASES FOR EVALUATION AND MANAGEMENT CODES WILL BE EFFECTIVE FOR 4/1/02, FOR COMMUNITY CARE PROVIDERS WHO PROVIDE SERVICES TO COMMUNITY CARE RECIPIENTS:                                          

CODE RATE CODE RATE CODE RATE CODE RATE
99201 $21.95 99218 $42.68 99238 $43.73 99347 $30.26
99202 $39.92 99219 $71.20  99283 $39.65 99348 $48.31
99203 $59.73 99220 $99.70 99284 $61.89  99349 $74.99
99204 $85.06 99221 $43.12 99285 $96.75  99350 $109.45
99205  $108.44 99222  $71.64  99342  $57.82 99432  $57.23
99211 $12.82 99223 $99.87 93343 $86.02  99381-99395 $51.00
99214 $51.00 99232 $35.41 99344 $111.65      
99215 $75.30 99233 $50.53 99345 $137.23       

THE FOLLOWING SPEC.CODES WILL BE INCREASED AS FOLLOWS FOR ALL PROVIDERS

CODE RATE CODE RATE CODE RATE CODE RATE
33960 $666.65  62270  $119.29 90784  $10.74 95810  $472.37
43760 $61.29 64640 $151.60 93501 $481.92 96410  $34.31
57452  $64.26 85102  $104.80 93510 $974.73     

REMINDER REGARDING COMMUNITYCARE RECIPIENTS

EFFECTIVE JULY 1, 2000, THE FOLLOWING CODES USED TO BILL FOR PHYSICIAN SERVICES RENDERED IN HOSPITAL EMERGENCY ROOMS, CPT CODES 99281, 99282, 99283, 99284, AND 99285, ARE NOT COUNTED IN THE TWELVE VISIT LIMIT FOR PHYSICIAN VISITS FOR ADULT RECIPIENTS - THIS IS APPLICABLE ONLY TO COMMUNITYCARE-ENROLLED RECIPIENTS. IN ADDITION, THE LIMIT OF THREE VISITS PER YEAR FOR REVENUE CODES HR450 AND HR459 IS NOT APPLICABLE TO COMMUNITYCARE RECIPIENTS. PROVIDERS SHOULD BE AWARE THAT THE ELIGIBILITY VERIFICATION SYSTEMS (REVS AND MEVS) MAY REFLECT A NUMBER OF ER VISITS REMAINING FOR A COMMUNITYCARE RECIPIENT, BUT THAT THERE IS NO LIMIT FOR HR450 AND HR 459 FOR COMMUNITYCARE ENROLLEES.  

QUESTIONS REGARDING THIS CHANGE MAY BE DIRECTED TO UNISYS PROVIDER RELATIONS AT 800 473-2783.

NOTICE TO PROVIDER OF PROFESSIONAL SERVICES

THE FEES FOR THE FOLLOWING CPT CODES WERE INCREASED EFFECTIVE WITH DATE 
OF SERVICE APRIL 1, 2002. 
33960 - EXTERNAL CIRCULATION ASSIST - $666.65 
43760 - CHANGE OF GASTROSTOMY TUBE; SIMPLE - $61.29 
57452 - EXAMINATION OF VAGINA - $64.26 
62270 - SPINAL FLUID TAP, DIAGNOSTIC - $119.26 
64640 - INJECTION TREATMENT OF NERVE - $151.60 
85102 - BONE MARROW BIOPSY - $104.80 
90784 - THERAPEUTIC INJECTION; IV - $10.74 
93501 - RT. HEART CATHETERIZATION; ONLY - $481.92 
93510 - LEFT HEART CATHETERIZATION; PERCUTANEOUS - $974.43 
95810 - POLYSOMNOGRAPHY, 4 OR MORE - $472.37 
96410 - CHEMOTHERAPY ADMINISTRATIVE, INTRAV - $34.31