RA Messages for September 4, 2001

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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.

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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.

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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. 

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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.

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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.

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NOTICE TO PROVIDERS OF LABORATORY SERVICES

EFFECTIVE WITH DATE OF SERVICE SEPTEMBER 1, 2001,FEES FOR THE LABORATORY  CODES LISTED BELOW WILL BE REDUCED IN ORDER TO BRING MEDICAID REIMBURSEMENT AMOUNTS FOR THESE CODES IN LINE WITH THOSE BEING PAID BY MEDICARE. THE NEW FEES WILL BE AS FOLLOWS: