RA Messages for June 19, 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:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF. DATE |
| ALBUTEROL |
AEROSOL |
90MCG |
OFF MAC |
05/24/01 |
PLEASE
MAKE THE FOLLOWING CHANGES TO THE 12/9/00 VERSION OF APPENDIX C:
| LABELER |
COMPANY |
BEGIN |
END |
| 55422 |
PHARMAKON LABS, INC |
10/01/01 |
|
| 64108 |
OPTICS LABORATORY, INC |
10/01/01 |
|
| 66073 |
HEALZ-PLUS,
INC |
10/01/01 |
|
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH
MAY HAVE BEEN INCORRECTLY PAID
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
EFFECTIVE WITH DATE OF SERVICE FEBRUARY 1, 2001, CPT CODE 88358
(MORPHOMETRIC ANALYSIS:TUMOR) WAS MADE PAYABLE AT A RATE OF $139.19 FOR THE FULL SERVICE AND $199.83 FOR THE
PROFESSIONAL SERVICE.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
PAGE 93 OF THE 1998 PROVIDER TRAINING PACKET STATES THAT PROVIDERS WILL NOT BE REIMBURSED FOR THE REMOVAL OF KELOIDS IF REMOVAL IS/WAS FOR COSMETIC REASONS. THE
INITIAL DIAGNOSTIC VISIT IS EXCLUDED FROM THIS
POLICY; HOWEVER. REIMBURSEMENT FOR THE INITIAL DIAGNOSTIC VISIT WILL BE MADE.
NOTICE TO CERTIFIED NURSE PRACTITIONERS
EFFECTIVE WITH DATE OF SERVICE APRIL 1, 2001, LOCALLY ASSIGNED CODE
X9921 (LUNELL MONTHLY CONTRACEPTIVE INJECTION) HAS BEEN ADDED TO THE LIST OF CODES PAYABLE TO CERTIFIED NURSE PRACTITIONERS. IF YOU HAVE BILLED FOR LUNELL SINCE APRIL 1, 2001 AND HAD BEEN DENIED, PLEASE RESUBMIT YOUR CLAIM.
NOTICE TO DENTAL PROVIDERS
CLARIFICATION OF ADULT DENTURE PROGRAM - PARTIAL DENTURE POLICY THIS NOTICE IS
TO PROVIDE CLARIFICATION OF EXISTING ADULT DENTURE PROGRAM
-PARTIAL DENTURE POLICY WHICH CAN BE FOUND ON PAGES 5-12 AND 5-13 OF THE MEDICAID DENTAL SERVICES MANUAL.
REMOVABLE ACRYLIC PARTIAL DENTURES WILL ONLY BE PROVIDED AS A PROGRAM BENEFIT IN THE FOLLOWING SELECT INSTANCES:1)THE PARTIAL DENTURE MUST
OPPOSE A FULL DENTURE; AND 2)THE RECIPIENT MUST BE MISSING AT LEAST TWO ANTERIOR TEETH, OR MISSING AT LEAST FOUR POSTERIOR TEETH ON EITHER SIDE
OF THE ARCH FOR WHICH THE PARTIAL DENTURE IS REQUESTED; AND 3)THE POTENTIAL ABUTMENT TEETH SHOULD BE CARIES FREE OR PROPERLY RESTORED,
PERIODONTIALLY SOUND TO LAST FOR SEVEN YEARS. ON PARTIAL DENTURE AND ONE RELINE PER ARCH ARE ALLOWED IN A SEVEN-YEAR
PERIOD. THE DELIVERY OF A PARTIAL DENTURE PREVENTS AN AUTHORIZATION OF A COMPLETE DENTURE FOR THAT ARCH FOR SEVEN YEARS. THE
PROGRAM DOES NOT PROVIDE OR FUND TWO PARTIALS IN THE SAME ORAL CAVITY.
SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS POLICY, YOU MAY CONTACT THE LSU SCHOOL OF DENTISTRY BY CALLING 504-619-8589.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
IT HAS COME TO OUR ATTENTION THAT MANY PROVIDERS HAVE BEEN USING ADD-ON PROCEDURE CODES AS PRIMARY PROCEDURE CODES. THESE CODES CANNOT BE USED THIS WAY.
EFFECTIVE IMMEDIATELY, ADD-ON CODES MUST BE MODIFIED WITH A 51 MODIFIER.
THEY CANNOT BE BILLED AS PRIMARY PROCEDURES. IF AN ADD-ON CODE IS PAID AS A PRIMARY PROCEDURE BECAUSE IT WASN'T MODIFIED WITH A 51, THE CODE
WHICH APPEARS TO REPRESENT THE PRIMARY PROCEDURE WILL BE DENIED WITH ERROR EDIT 563(ADJUST ADD-ON CODE WITH 51 MODIFIER) AND WILL NOT BE PAID UNTIL THE ADD-ON CODE HAS BEEN ADJUSTED WITH A 51 MODIFIER.
NOTICE TO PROVIDERS OF PROFESSIONAL
SERVICES
THE CPT CODES WHICH WERE DISCONTINUED IN THE YEAR 2001 ISSUANCE OF THE
CURRENT PROCEDURAL TERMINOLOGY WILL BE PLACED IN NON-PAY STATUS ON OUR FILES EFFECTIVE WITH DATE OF SERVICE JULY 1, 2001.
PLEASE PROGRAM ACCORDINGLY.