RA Messages for June 22, 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.
NOTICE TO PROVIDER OF PROFESSIONAL SERVICES
AS PER MEDICARE POLICY, THE FOLLOWING CODES HAVE BEEN MADE
PAYABLE EFFECTIVE 01-01-2004 FOR CROSSOVERS ONLY.
G0317 - DIALYSIS, 4 OR MORE VISITS PER MONTH - $289.72
G0318 - DIALYSIS, 2-3 VISITS PER MONTH - $241.19
G0319 - DIALYSIS, 1 PHYSICIAN VISIT PER MONTH - $192.67
G0323 - MANAGEMENT OF HOME DIALYSIS (ENTIRE MONTH) - $241.19
G0327 - MANAGEMENT OF HOME DIALYSIS (PARTIAL MONTH ONLY) - $8.22
ATTENTION HOME HEALTH PROVIDERS
PRIOR TO HIPAA, WHEN AN AGENCY BILLED FOR EXTENDED SKILLED
NURSING SERVICES (HOME HEALTH), AGENCIES USED THE CODES X9902 AND X9907
(MULTI-RECIPIENTS). IT DID NOT MATTER WHO PERFORMED THE SERVICE, RN OR LPN, AS
THEY WERE PAID AT THE SAME RATE.
WITH HIPAA, MEDICAID MAPPED TO 2 SEPARATE CODES (S9123 FOR RN
AND S9124 FOR LPN). THE ONLY TIME AN AGENCY NEEDS TO USE A MODIFIER IS IF THERE
ARE MULTI-RECIPIENTS. AT THE TIME, THE AGENCY WOULD REQUEST AND BILL A TT
MODIFIER.
AS PER THIS NOTICE, PRIOR AUTHORIZATION REQUESTS FOR S9123 OR
S9124 WILL BE DENIED IS ANY MODIFIER OTHER THAN TT IS REQUESTED.