JUNE 1992

Unisys Name Change Recipient Eligibility Verification System
Provider Relations Claims Resolution Procedures
Recipient Telephone Inquiries Refunds and Voids
1992 CPT Procedure Codes Antibiotic Injections
Allergen Immunotherapy Hearing and Speech Testing
Federal Upper Limits Suspended Lithium: Educational Article
CAPD Services Recipient Concerns
158-C Requests Wheelchairs
The Augmentative Communication Device Prior Authorization No Longer Necessary

Billing CPT-4 Codes

All Providers

Unisys Name Change

Unisys/LA. Medicaid is now operating under the name Paramax Systems Corporation, a Unisys company.  Paramax Systems Corporation, headquartered in McLean, Virginia, is a $2 billion information systems company with 17,000 employees.  A subsidiary of Unisys Corporation, Blue Bell, Pennsylvania, Paramax is an experienced leader in complex systems integration, custom electronic products, and related professional services for civil and defense agencies of the U.S. Government, Canada, and nations on five continents.

Our recent name change, however, need not concern the Medicaid provider community in Louisiana.  Now, more than ever, we are dedicated to meeting our customer's needs and expectations.  Paramax has a long history of proven performance and a long list of satisfied customers.

Paramax is market-driven and technology-enabled.  Simply put, we develop and apply leading-edge technologies to meet our customer's needs and requirements.  We blend our technical substance with a corporate style that stresses quality, cost-effectiveness, program performance, and partnership with out customers.

Ultimately, what makes Paramax special is the proud reputation we've achieved among our customers for being a responsible contractor, for keeping promises, for getting the job done.

Our promise to the provider community of Louisiana is to build on our core strengths and to forge new partnerships in the years to come.

Recipient Eligibility Verification System

We would like to encourage providers to use our new computerized Recipient Eligibility Verification System.  To access the system, providers must telephone (800) 776-6323 and have their seven-digit Provider I.D. number, as well as the appropriate thirteen-digit recipient number and date of service, available.  Procedural instructions will be given via voice response prompt messages.

Those providers who are familiar with the procedures for entering information need not wait for the voice response prompt messages; instead, they may begin entering information as soon as they have accessed the system.

To discontinue the service, providers must press *9 on their touch-tone telephones.  Otherwise, the service will be continued for another 90 seconds, even if the provider has already hung up the telephone.

Provider Relations

The Provider Relations inquiry staff strives to respond to provider inquiries quickly and efficiently.  However, due to the number of incoming calls for other departments that must be transferred out of Provider Relations, the inquiry staff is having difficulty responding to Provider Relations related inquiries in a timely manner.  Thus, to help us serve the provider community better, we are requesting that providers telephone Provider Relations only when they have questions concerning printed policy, claims processing problems, or the status of particular claims.

NOTE:  We request that providers review and reconcile their Remittance Advices before they call Provider Relations for the status of a claim.

Providers who have questions concerning EMC may telephone (504) 924-7051.

Providers who have questions concerning Prior Authorization may telephone (504) 928-5263 or 1-800-488-6334.

NOTE:  PA claims billing problems, however, should be addressed to Provider Relations.

Providers requesting check amounts, eligibility information, and the number of remaining recipient days or visits may call our VIPS line at 1-800-776-6323.

NOTE:  Effective immediately, we are no longer able to transfer providers out of Provider Relations to other departments.

Recipient Telephone Inquiries

The Provider Relations telephone unit is set up to receive telephone inquiries from providers, not recipients.  We do not have access to any information that could benefit recipients.  Therefore, we ask that providers not issue our telephone number to their Medicaid patients.  Recipient inquiries tie up our lines disproportionately so that we are unable to process provider inquiries in an efficient and timely manner.

If recipients have problems with eligibility, it is appropriate to refer them to their eligibility worker at the parish office.  If providers have difficulties with filing claims, they should call Provider Relations for assistance.

Claims Resolution Procedures

Providers should note that hospital claims only may be sent to the attention of Sandra Victor for consideration of an override of the two-year timely filing limitations.  All other claims should be sent to the attention of their respective programs, such as Pharmacy, Physician, or Transportation Programs.

It should be noted that a two-year override will only be considered for cases involving retrospective eligibility or an administrative error.  Claims not adjudicated within the two-year time frame as a result of provider error will not be considered for an override.  If a claim involves retroactive eligibility or a provider feels that an administrative error has occurred, the provider must submit documentation to substantiate the claim and attach documentation of timely filing in order to be considered for an override of the two-year timely filing limitations.

Refunds & Voids

Instead of simply refunding payments when errors in billing occur, e.g., duplicate payments, providers should initiate claim adjustments or voids.  However, should providers find it necessary to refund a payment, they should make checks payable to the Department of Health and Hospitals, Bureau of Health Services Financing, and they should mail the refunds to the following address:

Division of Fiscal Management
Financial Management Section
P. O. Box 91117
Baton Rouge, LA  70821-9117

NOTE:  Checks should not be made payable to Paramax.

To ensure that accounts are reconciled appropriately, providers must attach a copy of the Remittance Advice to their return check.

To determine the amount of a refund, providers should consider the following rules:

       Whenever a duplicate payment is made, the full amount of the second payment must be refunded.

       If another insurance company pays after Medicaid has made its payment, and the TPL payment is greater than the Medicaid payment, the full amount of the Medicaid payment should be refunded.

NOTE:  Providers should never submit a void and a refund for the same payment amount.

Physicians Only

1992 CPT Procedure Codes

The 1992 CPT procedure codes have been priced and placed on the procedure/formulary file effective with date of service January 1, 1992.  You may begin billing these codes immediately.  The fees for these codes are provided in the Attachments section of this issue of the Provider Update.  Please remove this attachment and add it to your 1992 Professional Services Fee Schedule.

Antibiotic Injections

Currently, the only antibiotic injections payable by the Physicians Program are injections of procaine penicillin or bicillin for recipients under the age of 21.  These two injections are billed by use of procedure code 90782.

Effective with date of service May 1, 1992, all other antibiotic injections will become payable as well, but only for recipients to the age of 21.

Providers should continue to bill for these injections by using procedure code 90782.  The reimbursement rate for all antibiotic injections will be $8.27.

These injectables have no limitations.

Allergen Immunotherapy

Effective immediately, the submittal of documentation on claims for procedure codes 95150 and 95155 (Professional service for the supervision and provision of antigens for allergen immunotherapy; single or multiple antigens, one multiple dose vial or two or more multiple dose vials) is no longer necessary because the computer has been programmed to accept and pay claims for these two codes without their pending to the MRT for review.

Even though these claims will no longer pend, Medicaid policy in regards to these two codes remains the same.  Only one claim line per provider, per recipient, per every 90 days, will be payable.  A second claim line in the same 90-day period will deny with error edit 733.  If a provider fails to bill for a 3-month supply on the first claim, the provider will have to file an adjustment to get correct payment.

Physicians, Speech Pathologists, Audiologists, School Boards, & Rehab Centers

Hearing & Speech Testing

The following policy has been adopted by the Bureau of Health Services Financing regarding the provision of certain hearing and speech testing services.

Now, we will require that speech pathologists and audiologists meet state licensure as follows:

       By having obtained a certificate of clinical competence from the American Speech and Hearing Association;

       By having completed the equivalent educational and work experience requirements for the certificate; and/or

       By having completed the academic programs by acquiring supervised experience to qualify for the certificate.

The following procedures and reimbursement requirements will be effective July 1, 1992.

Codes 92252 through 92585 will be limited to reimbursement once in 180 days.

The following codes are subject to the restrictions indicated and will now reimburse in accordance with the maximum fee amount shown.

Audiologic Function Tests with Medical Diagnostic Evaluation







92551 Screening test, pure tone, air only 4.00 Must be performed by RN, physician, audiologists or speech pathologist.


92552 Pure tone audiometry (threshold), air only 25.00 Audiometer, not handheld device, must be used.


NOTE:  The following codes except for codes 92567, 92568, and 92569, must be performed in a sound proof booth, by only an ASHA-certified audiologist or a physician otologist.  Audiometers must be calibrated once per year.








92553 Pure tone audiometry (threshold), air and tone 50.00 Bill either 92552 or 92553; do not bill both


92555 Speech audiometry; threshold only


92556 Speech audiometry; threshold and discrimination 25.00 Bill either 92555 or 92556; do not bill both


92557 Basic comprehensive audiometry 60.00 Bill this code only if both 92553 and 92556 are performed.  This code cannot be performed by a nurse.


92559 Audiometric testing of groups Bekesy audiometry; screening Bekesy audiometry; diagnostic Loudness balance test


Not payable  
92563 Tone decay test


92564 Short increment sensitivity index


92565 Stenger test, pure tone


92566 Impedance testing Not payable Deleted in 1991 CPT-4


92567 Tympanometry (Impedance testing)


92568 Acoustic reflex testing


92569 Acoustic reflex decay test 36.00  
NOTE:  The following codes may be performed by physicians and ASHA-certified practitioners:








92571 Filtered speech test 25.00 This code is not a preliminary test code.


92572 Staggered spondaic word test


92573 Lombard test


Not payable  
92574 Swinging story test


Not payable  
92575 Sensorineural acuity level test


92576 Synthetic sentence identification test


92577 Stenger test, speech


92578 Delayed auditory feedback test


Not payable  
92580 Electrodermal audiometry


Not payable  
92581 Evoked response audiometry


  Deleted in 1991 CPT-4
92582 Conditioning play audiometry


92583 Select picture audiometry 25.00 This code is the same as 92256.  Do not bill both codes.


92584 Electrocochleography


92585 Brainstem evoked response recording


92589 Central auditory function tests


Not payable  
92590 Hearing aid exam and selection; monaural


92591 Hearing aid exam and selection; binaural


92592 Hearing aid check; monaural


92593 Hearing aid check; binaural


92594 Electroacoustic evaluation for hearing aid; monaural


92595 Electroacoustic evaluation for hearing aid; binaural


92596 Ear protector attenuation measurements


Not payable  
X0401 Objective speech and language screening;


Not payable  
NOTE ON SURGERIES:  We are pleased to announce that we are increasing fees for the following surgeries:








42820 Tonsillectomy and adenoidectomy; under age 12


42821 Tonsillectomy and adenoidectomy; age 12 or over


42825 Tonsillectomy, under age 12


42826 Tonsillectomy, over age 12


42830 Adenoidectomy, under age 12


42831 Adenoidectomy, over age 12


69436 Tympanomastoid (requiring insertion of ventilating tube), general anesthesia 420.00 (for 2)  

Pharmacists and Prescribers

Federal Upper Limits Suspended

The Federal Upper Limits on the following drugs have been suspended:

Generic Name:

Gentamicin Sulfate Opth. Ointment

3 mg/gm                 Eff. 3/5/92


250 mg tablet           Eff. 3/5/92

Trihexyphenidyl Hydrochloride

2 mg tablet and 5 mg tablet

                           Eff. 3/5/92

Methenamine Hippurate

1 gm tablet              Eff. 4/29/92

Lithium:  Educational Article

Lithium is a monovalent cation possessing antimanic, antidepressant and antipsychotic activities.  This agent has been shown to be effective for the treatment and prophylaxis of recurrent episodes of acute mania.  It has demonstrated particular benefits in the treatment of bipolar disorder (previously referred to as Manic-Depressive Illness).

The onset of lithium's antimanic action may be slow.  Several days (3 to 14) may be required for lithium to exert its maximum antimania effect.  Initial therapy for symptomatic relief and behavioral control might warrant the use of a phenothiazine derivative or haloperidol, depending on the clinical situation.

It is recommended that serum levels be determined twice weekly during the first month of therapy and then weekly or when suspicion of toxicity or noncompliance is present.  To treat acute mania, lithium levels should be in the range of 1.0 to 1.5 mEq/L.  For prophylaxis and maintenance therapy, however, levels of 0.6 to 1.2 mEq/L are recommended.

Lithium should be avoided in patients with severe renal dysfunction and in lactating females.  Caution should be exercised in patients with significant cardiovascular disease, those presenting with dehydration or sodium depletion, and those requiring diuretic therapy.

Lithium toxicity may be categorized according to symptomatology and plasma lithium levels.  Mild toxic manifestations (LiCp <1.5 mEq/L) include:  fine hand tremor, GI upset, mild polyuria, polydipsia, and muscle weakness.  Moderate toxicity (LiCp 1.5 - 2.5 mEq/L) includes:  coarse tremor, twitching; recurrence of GI upset, slurred speech, vertigo, sedation, lethargy, and hyperreflexia.  Severe toxicity (LiCp > 2.5 mEq/L) includes:  seizures, stupor, coma, cardiovascular collapse, and death.

NOTE:  Levels should be drawn at least 10 to 12 hours after the last dose.

The narrow therapeutic range of lithium, together with the severity of lithium toxicity, makes it difficult to manage patients receiving other drugs capable of altering lithium blood levels.  Patients require frequent monitoring of lithium levels with resultant changes in dosages to maintain blood levels within the desired therapeutic ranges without concomitant toxicities.  Lithium levels are know to be affected by therapeutic agents which increase or decrease lithium elimination.

The chronic use of thiazide diuretics in combination with lithium may result in a decreased lithium clearance and a clinically significant increase in lithium levels and toxicity.  However, lithium and thiazide diuretics can be co-administered safely provided lithium levels are monitored and the patient is observed for signs and symptoms of toxicity.  Dosage adjustments may be necessary to maintain proper therapy in these patients.

Increases in serum lithium levels have also been reported following chronic administration of diclofenac, ibuprofen, indomethacin, naproxen, and piroxicam, possibly due to NSAID interference with prostaglandin production and decreased lithium excretion.  Monitoring and adjustments of lithium dosage may similarly be necessary when adding or changing NSAID therapy.

Dose Adjustment Suggestions:

In compliant patients, dosage adjustments to compensate for hydrochlorothiazide's effect on lithium clearance can be calculated as follows:

Formula One

DLiCl=                 (LiCp1 - LiCp2) (100%)      



DLiCl=change in lithium clearance

LiCp1=lithium level before HCTZ added

LiCp2=lithium level after HCTZ added

The adjusted lithium dose (in mEq/day) can be calculated by:

Formula Two

LiD2= (LiD1) (1 + DLiCl)


300 mg lithium carbonate equals approximately 8mEq of lithium

LiD1=original dose of lithium (in mEq/day)

LiD2=adjusted dose of lithium (in mEq/day)


A patient on 1200 mg/day lithium carbonate (32 mEq/day) is started on standard HCTZ therapy.

Using Formula One:




Using Formula Two:

         LiD2=(32 mEq/day)(1 + (-.44)

         LiD2=17.92 mEq/day(where 300 mg lithium carbonate = 8mEq)

Therefore, an adjusted dose of lithium to compensate for HCTZ effects on lithium clearance would be approximately 600 mg/day (300 mg bid) of lithium carbonate.

Other lithium drug-drug interactions, however, may be unrelated to changes in lithium blood levels.  The combination of lithium with either haloperidol or carbamazepine represents two such interactions of clinical significance.  Patients receiving these combinations of drugs require close supervision.  Several reports suggest that the combination of lithium/carbamazepine is responsible for a variety of neurotoxic effects including lethargy, muscular weakness, ataxia, tremor, and hyperreflexia, while blood levels of both agents may remain unchanged.  On the other hand, combination therapy is claimed to have a synergistic effect in controlling mania.

Combinations of lithium with haloperidol is also known to produce a toxic syndrome, consisting of weakness, lethargy, tremors, confusion, stupor, fever, extrapyramidal symptoms and dystonias, leukocytosis, elevated serum enzymes, and blood urea nitrogen, although numerous others have demonstrated that the combination can be used safely with adequate monitoring.

Management of reported drug-drug interactions involves a combination of awareness and appropriate monitoring.  With a knowledge of the complete drug regime and lithium levels, the physician may determine an appropriate course of action (or inaction).  These drug-drug interactions require management similar to that employed for lithium therapy in general.  The physician needs to be aware of medications which may have been prescribed by other physicians.  Monitoring programs consistent with good medical practice, including blood lithium determinations and assessment of patient symptoms, may ameliorate potential harmful effects of combination therapies.

Hemodialysis Centers

CAPD Services

Medicaid of Louisiana recently approved payment of Continuous Ambulatory Peritoneal Services (CAPD) provided by Hemodialysis Centers, effective retroactive to July 1, 1991.  More recently, Medicaid of Louisiana approved payment to Hemodialysis centers at the same rate as Medicare for the hemodialysis and CAPD services.  The effective date for this change was April 1,1992.

Hemodialysis centers were notified of the approval for payment for CAPD services and of the requirements to participate in a memorandum dated February 13, 1992.  They were notified of the new payment methodology in a memorandum dated March 16, 1992.

DME Suppliers

Recipient Concerns

Recently, we have received a number of calls from recipients, indicating that the quantity of an item or a supply dispensed is less than the quantity authorized by the Paramax Prior Authorization Unit.  Further research indicates that the amounts billed by the providers for these claims are equal to the prior authorized amounts.  Thus, providers should review their billing practices to ensure that claims reflect actual services provided and that providers are not billing for services which may not have been provided.

158-C Requests

Requests formerly made on the 158-C form are now made on the PA01 form.  Providers should ensure that these PA01 forms are sent to Paramax at the following address:

Paramax Systems Corporation
Prior Authorization Unit
P. O. Box 14919
Baton Rouge, LA  70898-4919

Providers should no longer send completed 158-C forms or PA01 forms to the Bureau of Health Services Financing.


In an effort to clarify bidding procedures on wheelchairs, we are publishing the following statement.

The physical therapist, the social worker, the recipient, or the Prior Authorization Unit must obtain three bids on any special type of wheelchair costing more than $1000.00.  The provider of service is not allowed to obtain these bids.

The expedite the bidding process, providers should attach the seating evaluation to the prior authorization request, and, if that is not available, the provider should attach the following specifications:  the patient's weight, the specific equipment required, and the measurements of the chair.

The Augmentative Communication Device

Effective May 1, 1992, program coverage was expanded to include Augmentative Communication Devices (ACDs) for recipients to the age of 21 only.  The procedure code for the basic unit is Z0629, and the procedure code for the accessories is Z0619.

Rehabilitation Services Provider

Prior Authorization No Longer Necessary

Effective May 1, 1992, Medicaid of Louisiana will no longer require prior authorization of evaluations for outpatient physical, occupational, and speech therapy services.  Payment will be limited, however, to no more than one evaluation, per recipient, every 180 days to the same provider.

NOTE:  Therapy treatment plans will continue to require prior authorization.

Oral Surgeons

Billing CPT-4 Codes

Effective July 1, 1992, oral surgeons will be allowed to bill CPT-4 codes appropriate to their specialty.  Providers should consult their CPT-4 for appropriate codes.  The list of codes in the Dental Services Provider Manual will be obsoleted.

Also, we will allow oral surgeons to use any appropriate ICD-9-CM codes available.  The list in the manual will no longer be limited to the 11 diagnoses listed.

Scan Attachments 4 pages