RA Messages for September 21, 2004

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PLEASE NOTE THE FOLLOWING CHANGES TO APPENDIX C:

LABELER	COMPANY	BEGIN	END
08290	BD BECTION DICKINSON		10/01/04
61073	AMKAS LABORATORIES		10/01/04
63807	EXCELSIOR MEDICAL CORP		10/01/04
65759	D&K HEALTHCARE RESOURCES, INC.		10/01/04
66378	PRESUTTI LABORATORIES, INC.	10/01/04
68188	ALLIANT PHARMACEUTICALS	10/01/04
68712	JSJ PHARMACEUTICALS	10/01/04
68782	EYETECH PHARMACEUTICALS	10/01/04

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

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ATTENTION EPSDT HEALTH SERVICES PROVIDERS

THIS MESSAGE CORRECTS THE PROCEDURE CODES FOR PSYCHOLOGICAL EVALUATION/ RE-EVALUATION GIVEN IN THE 2004 EPSDT HEALTH SERVICES TRAINING PACKET FOR HIPAA IMPLEMENTATION. MEDICAID LOCAL CODE X0413 WAS ERRONEOUSLY MAPPED TO "NEW HIPAA CODES" 90801 OR 90802. THE CORRECT HIPAA COMPLIANT CROSS-REFERENCE FOR LOCAL CODE X0413(PSYCHOLOGICAL EVAL/RE-EVAL) IS CPT CODE 96100(PSYCHOLOGICAL TESTING....WITH INTERPRETATION AND REPORT). PROVIDERS WHO HAVE PREVIOUSLY SUBMITTED CLAIMS USING THE "NEW HIPAA CODES" 90801 OR 90802 LISTED IN THE TRAINING PACKET SHOULD NOT VOID THESE CLAIMS. HOWEVER, EFFECTIVE SEPTEMBER 20, 2004, CPT CODE 90801 AND 90802 SHOULD NO LONGER BE USED FOR PSYCHOLOGICAL EVALUATIONS FOR EPSDT HEALTH SERVICES PROVIDERS. 

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ATTENTION PROFESSIONAL SERVICES PROVIDERS

EFFECTIVE WITH DATE OF SERVICE JULY 1, 2004, THE FOLLOWING CPT CODES WERE ADDED TO THE LIST OF CODES PAYABLE TO CLINICAL NURSE SPECIALIST, CERTIFIED NURSE PRACTITIONER AND NURSE MIDWIFE. 

51600, 51700, 51725, 51726, 51741, 51772, 51784, 51795, 51797, 51760.

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ATTENTION ALL DENTAL PROVIDERS ADDITIONAL DENTAL POLICY 

DENTAL SERVICES SHOULD NOT BE SEPARATED OR PERFORMED ON DIFFERENT DATES OF SERVICE SOLELY TO ENHANCE REIMBURSEMENT. IF NO RESTORATIVE OR OTHER TREATMENT SERVICES ARE NECESSARY, ALL SEALANTS MUST BE PERFORMED ON A SINGLE DATE OF SERVICE. IF RESTORATIVE OR OTHER TREATMENT SERVICES ARE NECESSARY, SEALANTS MAY BE PERFORMED ON THE SAME DATE OF SERVICE AS THE RESTORATIVE OR OTHER TREATMENT SERVICES. UNLESS CONTRAINDICATED, ALL RESTORATIVE AND TREATMENT SERVICES PER QUADRANT MUST BE PERFORMED ON THE SAME DATE OF SERVICE. THIS ALLOWS THE DENTIST TO COMPLETE ALL RESTORATIVE TREATMENT IN THE AREA OF THE MOUTH THAT IS ANESTHETIZED. IN ADDITION, IF THERE IS A SIMPLE RESTORATION REQUIRED IN A SECOND QUADRANT, THE SIMPLE RESTORATIVE PROCEDURE IN THE SECOND QUADRANT MUST ALSO BE 
PERFORMED AT THE SAME APPOINTMENT. IF THERE ARE CIRCUMSTANCES THAT WOULD NOT ALLOW RESTORATIVE TREATMENT IN THIS MANNER, THE CONTRAINDICATION(S) MUST BE DOCUMENTED IN THE PATIENT'S DENTAL RECORD. A LEAD APRON AND THYROID SHIELD MUST BE USED WHEN TAKING ANY RADIOGRAPHS REIMBURSED BY THE MEDICAID PROGRAM. WHEN TAKING RADIOGRAPHS, THE USE OF A LEAD APRON AND THYROID SHIELD IS GENERALLY ACCEPTED STANDARD OF CARE PRACTICE, AND IS PART OF NORMAL, ROUTINE, RADIOGRAPHIC HYGIENE. SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS INFORMATION, YOU MAY CONTACT THE DENTAL MEDICAID UNIT BY CALLING 504-619-8589.