RA Messages for August 28, 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 C:

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

---

HEMODIALYSIS CENTERS

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2001 MEDICAID OF LOUISIANA WILL CHANGE THE CURRENT PAYMENT METHODOLOGY FOR REIMBURSEMENT OF THE DRUG EPOGEN (EPO). THE NEW REIMBURSEMENT WILL BE PAID PER 1,000 UNITS ADMINISTERED, NOT TO EXCEED THE MEDICARE RATE AS OF JUNE 30, 2001.  CLAIMS WILL NO LONGER BE REVIEWED FOR MEDICAL DOCUMENTATION THAT MEET THE CRITERIA TO ADMINISTER OVER 10,000 UNITS. 

---

NOTICE TO PROVIDERS OF PROFESSIONAL SERVICES

YOUR ATTENTION IS CALLED TO THE APRIL/MAY ISSUE OF THE PROVIDER UPDATE, PAGE 3. IN THE ARTICLE ENTITLED CHANGE TO OB SONOGRAM POLICY,A WORDING  ERROR WAS MADE IN PARAGRAPH 2. THE PARAGRAPH SHOULD READ, "ONE COMPLETE  SONOGRAM (EITHER 76805 OR 76810) AND TWO FOLLOW-UP SONOGRAMS (EITHER  TWO 76815S, TWO 76816S OR A COMBINATION OF 76815 AND 76816) WILL BE  REIMBURSED PER RECIPIENT PER 270 DAYS AMONG ALL PROVIDERS." 

---

NOTICE TO AMBULANCE PROVIDERS

HCPCS CODES A0380 (BLS MILEAGE) AND A0390 (ALS MILEAGE) WERE DISCONTINUED EFFECTIVE WITH DATE OF SERVICE JULY 1, 2001 IN ERROR. YOU ARE TO CONTINUE BILLING THESE CODES UNTIL FURTHER NOTICE.  ALL CLAIMS DENIED (WITH EFFECTIVE DATE OF SERVICE 7/01/2001 - PRESENT) FOR ERROR CODE 248 "DELETED, BILL CURRENT CODE" WILL BE RECYCLED FOR  PAYMENT.

---

NOTICE TO HOME HEALTH AGENCIES

MEDICAID WILL NOW P AY FOR EXTENDED HOME HEALTH SERVICES PROVIDED OUTSIDE OF THE HOME FOR MEDICALLY FRAGILE RECIPIENTS UNDER THE AGE OF 21 TO ACCOMMODATE THE RECIPIENT'S NORMAL LIFE ACTIVITIES. ANY QUESTIONS REGARDING THIS CAN BE DIRECTED TO DAWN MATTE AT (225) 342-8223. 

---

NOTICE TO KIDMED PROVIDERS

THIS MESSAGE IS TO EMPHASIZE THE POLICY CONCERNING EPSDT CONSULTATION CODES X0180-X0182 AND X0187-X0189. THE DESCRIPTION OF THESE CODES FOUND IN THE KIDMED MANUAL ARE FOR ONE (1) FACE TO FACE CONTACT. MULTIPLE UNITS MAY NOT BE BILLED FOR THE SAME CONTACT. 

---

NOTICE TO PROVIDERS OF CRITICAL CARE SERVICES

PAGE 25-2 OF THE PHYSICIAN SERVICES MANUAL INDICATES THAT CPT CODES 93000, 93010, 93040, AND 93042 ARE INCLUDED IN CODES 99291 AND 99292. THEREFORE, AT THIS TIME, THEY CANNOT BE BILLED SEPARATELY. THIS POLICY WAS MADE BEFORE THE DESCRIPTORS IN CPT LISTED THE CODES INCLUDED IN 99291 AND 99292 AND 99295-99298, HOWEVER, SO EFFECTIVE WITH DATES OF SERVICE APRIL 1, 2001, PROVIDERS WILL BE ALLOWED TO BILL CPT CODES 93000, 93010, 93040, AND 93042 IN ADDITION TO 99291 AND 99292 AND/OR 99295-99298 ON THE SAME DATE OF SERVICE FOR THE SAME RECIPIENT. 

CPT CODES 99291, 99292, 99295, 99296, AND 99298 ARE GLOBAL CODES WHICH CONTAIN COMPONENT CODES. THE COMPONENT CODES ARE NOT TO BE PAID ON THE SAME DATE OF SERVICE AS THE GLOBAL CODE TO THE SAME PROVIDER FOR THE SAME RECIPIENT. AS SOON AS PROGRAMMING CAN BE COMPLETED, PAYMENT FOR THE COMPONENT CODES WILL BE RECOUPED IF PAID TO THE SAME PROVIDER FOR THE SAME RECIPIENT ON THE SAME DAY AS THE GLOBAL CODE. EXCLUDED FROM THIS PROGRAMMING WILL BE PROCEDURE CODES 71010, 71015, AND 71020. THE COMPONENT CODES FOR EACH OF THE GLOBAL CPT CODES CAN BE FOUND ON PAGES 19, 20, AND 21 OF THE 2001 CURRENT PROCEDURAL TERMINOLOGY.