RA Messages for May 8, 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

**NOTE MAC PRICE CORRECTION FOR ABOVE 2 PRODUCTS.  THE NEW FUL WAS SHOWN,HOWEVER, THE STATE MAC WHICH IS LOWER TAKES PRECEDENCE.** 

 PLEASE MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:

 PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID.

ATTENTION PHARMACY PROVIDERS

THE PHARMACY BENEFITS MANAGEMENT SECTION HAS RESTRUCTURED. WE ARE PROVIDING YOU WITH UPDATED CONTACT INFORMATION. 
M.J. TERREBONNE, PHARMACY DIRECTOR - 225/342-9768 
RACHEL BROUSSARD, POLICY AND OPERATIONS - 225/342-9768 
MELWYN WENDT, AUDITS AND LOCK-IN - 225/219-4156 
GALE NADLER, LOCK-IN - 225/219-4156 
TIMOTHY WILLIAMS, REBATE - 225/342-5194 
GERALYN STOCKSTILL - 225/342-6046 
 RECIPIENT FILE CHANGES (CO-PAY EXPEMTION REQUESTS, TRANSPLANT DATES) 
FAX NUMBER - 225/342-1980 

NOTICE TO DME PROVIDERS

EFFECTIVE WITH DATES OF SERVICE APRIL 6, 2001 AND AFTER, THE BUREAU HAS INCREASED THE REIMBURSEMENT FOR OSTOMY SUPPLIES (HCPCS A4360-A4421, A5051-A5149, K0137-K0139, K0278-K0280 AND K0421-K0437) TO 80% OF THE MEDICARE FEE SCHEDULE, 80% OF THE MSRP OR BILLED CHARGES, WHICHEVER IS LESS.

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

EFFECTIVE WITH DATE OF SERVICE JUNE 1, 2001, CPT CODES 82044, 82055, AND 82962 WILL REQUIRE A QW MODIFIER. 

NOTICE TO CERTIFIED NURSE PRACTITIONERS

REIMBURSEMENT TO CERTIFIED NURSE PRACTITIONERS WITH A SPECIALTY IN  NEONATOLOGY FOR CPT CODES 32020 (TUBE THORACOSTOMY WITH OR WITHOUT WATER SEAL), 99255 (INITIAL INPATIENT CONSULTATION; NEW OR ESTABLISHED  PATIENT), AND 99360 (PHYSICIAN STANDBY SERVICES) WILL BECOME EFFECTIVE WITH DATE OF SERVICE JUNE 1, 2001. PLEASE NOTE THESE CODES ARE PAYABLE TO ONLY NEONATAL NURSE PRACTITIONERS. 

CERTIFIED NURSE PRACTITIONERS WITH A SPECIALTY IN WOMEN'S HEALTH WILL BE REIMBURSED FOR CPT CODES 76805 (ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED), 76816 (ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; FOLLOW-UP OR REPEAT), 76818 (FETAL BIOPHYSICAL PROFILE; WITH NON-STRESS  TEST), 76830 (ECHOGRAPHY, TRANSVAGINAL), 76856 (ECHOGRAPHY, PELVIC,  B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTAION; COMPLETE), AND 59025 (FETAL NON-STRESS TEST) EFFECTIVE THE SAME DATE. CNPS WITH SPECIALTIES  IN OTHER AREAS SHOULD NOT BILL THESE CODES.