JUNE 1997

Community Care Profile Correction Notice
Notice to KIDMED Providers LADUR Education Article
Changes in CPT Codes 96115 and 96117 Notice to All Non-Institutional Providers
Physician's Responsibilities Regarding the Authorization of Home Care Services J Code Adjustments
Denial of Claims in the 99381 Through 99385 Range Fee Increase for Depo-Provera
Shriners Hospital Services for Children  Clarification of Procedure Code 99211 by a Nurse
DME Procedure Code Changes Clarification of Global Surgery Period Policy
Clarification of Vaginal and Caesarean Deliveries Reminder to All Providers

Community Care Profile

Community Care is a managed care program administered by Medicaid of Louisiana.  As Community Care continues to grow across Louisiana, it becomes increasingly important that all providers understand how this program operates; which services require Primary Care Physician (PCP) approval and referral; what to look for to identify the Community Care Medicaid card; and how to bill using the PCP authorization number appropriately on the claim form.  Over the last few months more and more claims have denied because the claim does not indicate that a referral was received from the PCP for the services rendered.  We hope the following information concerning this program will assist providers in preventing denial of claims.

Twenty (20) parishes are currently participating in the Community Care program:  Bienville; Claiborne; DeSoto; Natchitoches; Red River; Sabine; St. Charles; Webster; East Carroll; Jackson; Madison; Morehouse; Richland; Union; West Carroll; Allen; Beauregard; Cameron; Jefferson Davis; and Vernon.  Approximately 43,000 recipients are currently enrolled in this program.  The number of parishes participating and the number of recipients enrolled are expected to increase over the next several months.

The program links Medicaid recipients in these participating parishes with a physician, clinic, Federally Qualified Health Center (FQHC), or Rural Health Clinic (RHC) that serves as the PCP for that recipient.  The PCP bears total responsibility for managing all facets of the recipient�s health care.

Recipients have the opportunity to select a participating doctor, FQHC, or RHC to be their primary care provider.  Usually, the PCP is located in the recipient�s parish of residence or, occasionally, in a contiguous parish.  If the recipient does not select a PCP by the deadline date, the recipient will be assigned a CommunityCARE PCP in their parish of residence.  Each Medicaid eligible recipient in a family chooses a PCP; thus the provider of services may see more than one PCP on a Medicaid ID card.

Community Care recipients receive a monthly Medicaid eligibility care showing the name and telephone number of the selected/assigned PCP(s).  This appears in the lower right corner of the card.  One Medicaid card is issued for each certified household.  Each eligible recipient�s name is listed on the card, and all applicable PCPs are listed on the card.  A number (1, 2, 3, etc.) in front of the recipient�s name will indicate a corresponding PCP�s name.  This indicates the PCP for that family member.

As indicated earlier, the PCP is totally responsible for managing the health care of his or her Community Care patients.  The PCP must refer a recipient to a specialist or medical facility for treatment which he does not provider but is medically indicated.  Written referrals for specialty care should be issued as soon as the PCP determines that the referral is required.

The referral must be for treatment of a specific illness or disease.  When the PCP refers a recipient to a specialist for treatment of an illness, the specialist should provide a copy of the PCP�s written referral for additional specialty services that may be required in the course of treating that illness.  However, if the specialist discovers a new condition that would require another medical specialty, the PCP must be advised.

All providers should be aware that even providers outside the Community Care parishes must have a PCP referral for all services which require PCP authorization.

If a recipient accesses emergency services directly, without going through the PCP, the PCP should be notified of the situation by the emergency physician after the medical examination and appropriate stabilizing measures have been undertaken.  If the PCP cannot be reached at that time to give authorization for services, the emergency physician must obtain post authorization for services and should contact the PCP within 24 hours.

In billing for services to a Community Care recipient which require a PCP referral, the seven-digit referral number must be on the claim form in the appropriate field as indicated below:

UB-92 � Block 83A for inpatient and outpatient claims
HCFA 1500 � Block 17A
Unisys 102 Claim Form (Rehabilitation Centers) � Block 12
Unisys 101 Claim Form (Home Health) � Block 10

 If the authorization number is not indicated in the designated field on the claim form, the claim will deny even if a copy of the referral is attached to the claim form (in fact, it is never necessary to attach a copy of the written referral to the claim form; the written referral should be kept for your records and for audit purposes).  The denial, error code 106, will indicate "�Provider not PCP or service not authorized by PCP"�  Please be sure to complete the claim form correctly prior to submission.

Further information concerning the Community Care program, as well as information on exempt services, may be obtained from the Unisys Provider Relations Department at (800) 473-2783 or (504) 924-5040.

Correction Notice to All Providers

In the April issue of the Provider Update, the article entitled �Unisys Provider Relations Reminders to Providers,� contained an error in the section �Claim Special Handling Reminders.�  The section incorrectly stated that overrides of the yearly outpatient visit maximum need to be accompanied with a 158-C form.  The correct form number is 158-A.  We apologize for the inconvenience.

Notice to KIDMED Providers

A brief review of a small sample of records has revealed that some KIDMED providers are billing for screenings without having completed all the required components of the screening.  Do not bill Medicaid for incomplete screenings.

Louisiana Drug Utilization Review (LADUR) Education

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):  A Review

Edwin H. Adams, R.Ph. Clinical Instructor Northeast Louisiana University School of Pharmacy


  • NSAIDs are one of the most commonly prescribed medications for a variety of conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and mild to moderate pain.

  • Although ibuprofen and aspirin have been �over the counter� products for some time, other NSAIDs, such as naproxen sodium and ketoprofen, are now available in �over the counter� strengths.

  • Adverse effects associated with NSAID therapy can cause profound morbidity and mortality, especially in those patients with certain risk factors.

Each day, approximately three million Americans take an NSAID for a variety of reasons, making these drugs one of the most commonly used and prescribed.1  Approximately 70 million prescriptions were written for NSAIDs in 1986 alone.  The use of over the counter NSAIDs is estimated to be five to seven times greater.2  Although these medications are efficacious in alleviating the pain and inflammation associated with certain joint conditions, dysmenorrhea, and headaches, they do have adverse effects associated with both short and long-term therapy.  Exacerbating potential problems is the fact that the primary users of NSAIDs are members of the geriatric population.  These patients in particular are at a substantially higher risk for developing complications from NSAID therapy.  This and other risk factors, in addition to the volume of usage, make NSAID usage a potential public health hazard.

Although there are five chemical classifications of NSAIDs, it is controversial as to whether there are indeed differences in the efficacy, mechanism of action, and safety profile between the drugs in each class and between the classes themselves.  Table 1 lists the various classifications of NSAIDs.  

Table 1.  The Classification of NSAIDs4  
Carboxylic Acids

-      Aspirin
-      salsalate (Disalcid�)
-      diflunisal (Dolobid�)
-      choline salicylate (Arthropan�)
-      choline magnesium salicylate (Trilisate�)
Acetic Acids
-      Etodolac (Lodine�)
-      Diclofenac (Cataflam�, Voltaren�)
-      Indomethacin (Indocin�)
-      Ketorolac (Toradol�)
-      Nabumentone (Relafen�)  

Propionic Acids

-      fenoprofen (Nalfon�)
-      flurbiprofen (Ansaid�)
-      Ibuprofen (Advil�, Motrin�)
-      ketoprofen (Orudis�, Oruvail�)
-      naproxen (Anaprox�, Naprelan�, and Naprosyn�)
-      oxaprozin (Daypro�)  


-      meclofenamate (Meclomen�)
-      mefenamic acid (Ponstel�)  


-      Phenylbutazone


-      piroxicam (Feldene�)  

The therapeutic efficacy of an NSAID in a particular patient is based on clinical response and usually cannot be predicted prior to initiation of therapy.  Patient responses are variable and highly individual.  Thus, NSAIDs should be prescribed for a trial period of six weeks.  Patient response should be re-evaluated at that time before an alternate therapy is chosen.  Dose maximization should be considered at this time.  However, it is not unusual for two or more NSAIDs to be tried before an effective agent is found.  Certain NSAIDs should be selected initially because they have been found to be more effective than other NSAIDs in specific conditions.  Indomethacin has demonstrated efficacy in ankylosing spondylitis, acute gout, and osteoarthritis.  Ibuprofen causes a lysosomal membrane stabilizing effect and preserves myocardial integrity in mycardial ischemia, whereas indomethacin and meclogenamic acid do not.  Postpartum pain is more effectively treated with naproxen sodium than free naproxen.  The efficacy of an agent may be dose dependent.  Small doses of an NSAID may be sufficient to produce analgesia, whereas larger doses may be required to produce anti-inflammatory activity.  The dose of such drugs as ibuprofen and fenoprofen should be maximized before an alternate agent is chosen.  However, the difference in dose and activity is very small for piroxicam and sulindac as compared to other NSAIDs.3  Over the counter NSAIDS are approved only for analgesic use, not anti-inflammatory use.  (See Table 2.)  

Table 2.  Over the Counter NSAIDS  

Ibuprofen (Advil�, Motrin�, others)  
Ketoprofen (Orudis KT�)  
Naproxen sodium (Aleve�)  

The major component of NSAID activity is believed to be related to a reduction of prostaglandin biosynthesis (PGHS-1 & PGHS-2) by cyclooxygenase inhibition.  (See Figure 1.)

Figure 1. Inhibition of Cyclooxygenase  

PGHS-1 can be found in vascular endothelial cells, platelets, and kidney collecting tubules, and the levels of PGHS-1 in the body remain relatively steady.  PGHS-2 concentrations are relatively low but are increasing during an inflammatory response.  Research is now focusing on selective inhibition of PGHS-2 to circumvent the adverse effects associated with PGHS-1 inhibition.

Most of the side effects associated with NSAID therapy are mild and abate upon discontinuing therapy.  There are, however, more serious adverse reactions that warrant further discussion.  The most serious of these problems involve the gastrointestinal (GI) tract.  It has been estimated that up to 20% of patients on NSAIDs are affected by GI problems.5  The FDA has estimated that 2%-4% of chronic NSAID users will develop upper GI bleeding, a symptomatic ulcer, or an intestinal perforation each year.  In addition, as many as 20,000 deaths occur annually as a result of NSAID-induced gastric injury.  Ulcer complications account for approximately 7,600 deaths and 76,000 hospitalizations each year.6  These ulcer complications are insidious in onset, especially in the elderly.  After three months of using NSAIDs, approximately 12% of patients have endoscopic evidence of a gastric ulcer and about 5% have evidence of a duodenal ulcer.7  Patients often remain asymptomatic until the GI events have reached a critical stage.  Although perforation can occur within a few days following initiation of therapy, most complications occur during chronic NSAID use.8  NSAIDs elicit these adverse events either by direct mucosal irritation or, more importantly, by inhibiting the protective components of the GI mucosa, the endogenous prostaglandins.  A common misconception is that one can avoid the adverse GI evens by administering the NSAID parenterally.  It is true that the direct mucosal irritation is avoided, but the protective prostaglandins in the gastric mucosa are still inhibited by the NSAID.  Some of the newer NSAIDs, including nabumetone and oxaprozin, have demonstrated a lower overall incidence of GI bleeding.  The new NSAIDs do not appear to inhibit gastric prostaglandin; therefore they do not interrupt the cytoprotective prostaglandin activity.9  Prophylaxis with misoprostal (Cytotec �) has been effective in the prevention of gastric and duodenal ulcers.  This prostaglandin analogue can reduce the incidence of serious NSAID-induced GI complications by up to 40%.10

NSAIDs exhibit varying degrees of anti-platelet activity by inhibition of platelet cyclooxygenase.  The resulting thrombocytopenia may contribute to the bleeding associated with GI mucosal damage.  There are several parameters which determine the amount of time required for normal platelet function to return.  One such factor is the extent to which a drug binds cyclooxygenase.  Aspirin, for example, irreversibly binds to the enzyme, thus inhibiting function the entire life of the thrombocyte.  Platelet activity is then dependent upon the production of new cells which takes seven to twelve days.  Ibuprofen and other NSAIDs reversibly bind to cyclooxygenase, thereby allowing normal platelet function to return once the drug has been eliminated.  For these products, the half-life of the drug ultimately determines how long it will take for the normal platelet function to return.11  (See Table 3.)  

Table 3.  NSAID Half-Lives

Short (<8 Hours)      dicolfenac  
mefenamic acid 
Medium (8 � 24 Hours)  diflunisal  
salicylate (dose dependent
Long (>24 Hours)  nabumetone  

One product in particular, piroxicam, is one of the longest acting NSAIDs available.  Its use in the elderly has been controversial and potentially dangerous.  It has even been proposed by certain patient activist groups that this product be removed from use in the elderly population.

Although NSAID therapy rarely causes significant adverse effects on the kidneys, there are certain patient populations at increased risk of developing untoward renal effects.  These include patient with congestive heart failure, cirrhosis, hypovolemia, or a pre-existing renal condition.  Prostaglandins control of the vasodilation of the renal vasculature.  NSAIDs cause a decrease in renal perfusion secondary to drug-induced vasoconstriction.  It is this reduction in perfusion, not the basal prostaglandin inhibition, which is responsible for the renal injury.  Renal function generally recovers soon after discontinuation of therapy.

Because NSAIDs are one of the most widely used medications in the United States, promoting their safe and effective use is important and represents a logical approach to practicing cost-effective medicine.  (Relative Costs, see Table 4.) 

Table 4.  Relative Costs of NSAIDs12  


Ketorlac (Toradol�)  


choline magnesium salicylate (Trilisate�)  
diclofenac (Voltaren�, generic available)  
diflunisal (Dolobide�)  
etodolac (Lodine�, generic available)  
ketoprofen (Orudis�, Oruvail�, generic available)  
nabumetone (Relafen�)  
naproxen (Anaprox�, Naprelan�, Naprosyn�, generic available)  
piroxican (Feldene�, generic available)  


fenoprofen (Nalfon�)  
ibuprofen (generic)  
indomethacin (Indocin�, generic available)  
meclofenamate (Meclomen�)  
salsalate (Disalcid�) 

In most patients, the benefits of NSAID therapy, outweigh the risks.  However, there are patients who should be monitored closely for adverse drug events.  These populations include:  the elderly; patients with a history of peptic ulcer disease or GI hemorrhage; patients on long-term NSAID therapy; patients on concomitant anticoagulant therapy or concomitant corticosteroid therapy; or patients with a history of heavy over the counter analgesic use.  The best means of preventing the complications of NSAID therapy is by careful consideration of each patient�s risk.  Patient education is another means of preventing complications.  Healthcare providers should discuss with the patient the proper dose, side effect, and expected outcomes from NSAID therapy.  Proper counseling in administration techniques, such as taking an NSAID with food, could help reduce GI discomfort and increase patient compliance.  Insufficient counseling in these areas could contribute to treatment failure.  Patients should be encouraged to contact their pharmacist or physician if symptoms worsen, recur, or fail to improve.


1.     CE Cooke.  �Disease Management:  Prevention of NSAID-induced gastropathy.�  MedscapeR Continuing Medical Education.  May 25, 1996.  (

2.     BI Hirschowitz.  �Non-Steroidal Anti-Inflammatory Drugs and the Gut.�  Southern Medical Journal, 1996. Vol. 89, No. 3. Pages 256-263.

3.     Clinical Pharmacology, Drug Monograph Service, v. 1.5.  Gold Standard Multimedia Inc. (

4.     LE Boh.  �Osteoarthritis.�  Pharmacotherapy, A Pathophysiologic Approach. 3rd Edition.  JT Dipiro, Appleton, and Lange (eds.); 1997.  Chapter 85, pages 1735-1753.

5.     LC Knodel.  �NSAID adverse effects and interactions.  Who is at risk?�  American Pharmacy, 1992.  NS 32:39-37.

6.     DC Conaway.  �Using NSAIDs safely in the Elderly.�  Hospital Medicine, May 1995.

7.     SM Kantor.  �NSAID-induced Risk Factors in ArthritisTherapy.�  A symposium review of the 1997 American Society of Consultant Pharmacists Annual Meeting.

8.     LC Knodel.  �NSAID adverse effects and interactions.  Who is at risk?�  American Pharmacy, 1992.  NS 32:39-37

9.     Clinical Pharmacology, Drug Monograph Service, v. 1.5.  Gold Standard Mulimedia Inc. (

10.  SM Kantor.  �NSAID-induced Risk Factors in Arthritis Therapy.�  A symposium review from the 1997 American Society of Consultant Pharmacists Annual Meeting.

11.  LC Knodel.  �NSAID adverse effects and interactions.  Who is at risk?�  American Pharmacy, 1992.  NS 32:39-37.

12.  Clinical Pharmacology, Drug Monograph Service, v.1.5. Gold Standard Multimedia Inc.

Notice to Providers:  Changes in CPT Codes 96115 and 96117)

Effective with date of service May 1, 1997, the number of neurobehavioral and neuropsychological testing procedures (CPT codes 96115 and 96117) a recipient can have will be limited to one per recipient per year.

If additional testing within the year is required, providers may submit hardcopy claims with documentation attached to support medical necessity.  These claims will be reviewed by the Medical Review Unit at Unisys.  Claims for the second and subsequent testings billed without supporting documentation will be denied.

Notice to All Non-Institutional Providers

If you are contacted by any of the following individuals, please immediately contact Bob Patience at (504) 922-2239, or write to him at Program Integrity, P. O. Box 65271, Baton Rouge, LA  70896

         Paul Seawell            Kent Plembeck         Marilyn Marion

         Joey LaFleur           Pat Colvin                 Mike Colvin

         Darlene Strahan       Archie Jefferson       Joe Taylor

Physician�s Responsibilities Regarding the Authorization of Home Care Services

Medical necessity for home health services and supplies must be certified by the ordering physician, who must complete HCFA Form 485.  (See HCFA Pub. 11, Section 240.1.)

In signing these documents the physician services that:

1)    the patient is under his/her care;

2)    these home health services are required and medically necessary;

3)    the patient is confined to his/her home as defined by the Bureau�s Homebound Criteria;

4)    there is a written plan for treatment;

5)    the plan will be reviewed periodically (at least once every 62 days) by him/her;

6)    the patient needs intermittent skilled nursing care and/or physical or speech therapy; or

7)    the patient needs occupational therapies.

Penalties which may be imposed on physicians for inappropriate certification (false attestation), which constitutes fraud, can include:

1)    referral to the Office of the Inspector General;

2)    criminal penalties in U.S. District Court, resulting in fines and/or a jail sentence;

3)    civil prosecution in a U.S. District Court, resulting in fines and/or settlements;

4)    civil monetary penalties with an administrative law judge resulting in fines ($2,000 per line item;

5)    if fraud is proven under the False Claims Act, tripling of damages and fines;

6)    simple sanction (barred from the Medicare and Medicaid programs) by the Washington Office of the Inspector General.  

Notice to Providers:  J Code Adjustments

Effective with date of service May 1, 1997, adjustments in fees were made to the following codes:  

  Code    Description   Fee
90703 Tetanus Toxoid for trauma  $  2.42  
J2910  Injection, gold therapy, arthritis $ 10.14  
J9260 Injection, Methotrexate Sod. 50 mg  $  5.50  
J9360 Velban Injection, 10mg/10cc  $  3.13  
J9390 Vinorelbine Tartrate, 10mg, Navelbine  $ 45.24  

Denial of Claims in the 99381 Through 99385 Range

Claims submitted with new patient preventive medicine codes in the range of 99381 through 99385 will be denied for any recipient who has received problem-oriented services from the same billing provider in the two years prior to the date of the preventive medicine visit.  Providers are to bill an established preventive medicine code if the recipient is asymptomatic.

As stated in the Winter-94 CPT Assistant, the initial new patient preventive codes are to be used to report services to a patient who has moved to a particular geographic area and is establishing himself/herself with a new physician without any representing illness.

Shriners Hospital Services for Children

Since 1922, Shrine hospitals have treated more than 500,000 children in their facilities through donations, wills, bequests, and membership dues.  The group'� commitment to excellent hospital care and research is unsurpassed in North America.  The Shriners actively engage in providing medical help to children at no cost.

The Shrine of North America operates orthopedic hospitals and three burn institutes free of charge to all children aged 1 through 18 years of age, regardless of race, creed, or religious affiliation.  It does not accept any governmental assistance or insurance payments.

For further information about the Shrine program, please contact Mr. Sumrall at 504/837-7418.

Fee Increase for Depo-Provera

The Bureau of Health Services Financing is pleased to inform you of an increase in fee for Depo-Provera for birth control, code J1055 to $37.59 effective with date of service May 1, 1997.

Clarification of Procedure Code 99211 by a Nurse

There has been some question as to whether code 99211 can be billed when performed by a nurse if the doctor is out of the office.  This code should NOT be billed if the doctor is out of the office.  Nurses must be under the personal supervision of the doctor.  �Personal� is defined as if �in the same location.�

DME Procedure Code Changes

The following HCPC procedure codes for DME items have been changed from a payable status to a non-payable status to match changes made by Medicare.  The effective date for the change will be 7/1/97, to allow for the processing of claims already in the system with the current codes.  Please discontinue the use of these codes immediately for the following DME items.  

A4200   K0208   K0236   K0256  
A4202   K0209   K0237   K0257  
A4204   K0210   K0238   K0258  
A4204   K0211   K0239   K0259
A4205   K0212   K0240   K0261  
K0126   K0213   K0241   K0262  
K0127   K0214   K0242   K0263  
K0128   K0215   K0243   K0264  
K0129   K0216   K0244   K0265  
K0130  K0217   K0245   K0266  
K0154  K0218   K0246   K0285  
K0196   K0219  K0247   K0402  
K0197   K0220   K0248   K0403  
K0198   K0221   K0249   K0405  
K0199   K0222   K0250   K0406  
K0203   K0224   K0251   L4200  
K0204   K0228   K0252   L7160  
K0205   K0229   K0253   L7165  
K0206   K0234   K0254    
K0207   K0235   K0255    

Additionally, the following HCPC procedure codes have been added to the DME Program as payable codes to match Medicare changes.  This change is being made with a retroactive effective date (1/1/97) to allow for processing by Medicaid of any crossover claims previously submitted to Medicare using these codes.  Please begin using these codes for all prior authorization requests for DME items.


A4211 Supplies: Maint of Drg Infsn Catheter

A4222 Supplies: Ext Drg Infsn Pump, cassette/bag

A4353 Intermit Urin Catheter, w/Insertion Pipes

A4365 Ostomy Adhesive Remover Wipes, 50/box

A4368 Ostomy Filter, Any Type, each

A4481 Tracheostoma Filter

A6025 Silicone Gel Sheet, each

A6154 Wound Pouch each

A6196 Alignate Dressing <=16 sq. in.

A6197 Alignate Dressing > 16 <=48 sq in.

A6198 Alignate Dressing > 48 sq. in.

A6199 Alignate Dressing Wound Filler

A6203 Composite Drsg. <-16 sq. in.

A6204 Composite Drsg. > 16 <=48 sq. in.

A6205 Composite Drsg. > 48 sq. in.

A6206 Contact Layer <= 16 sq. in.

A6207 Contact Layer > 16 <=48 sq in.

A6208 Contact Layer > 48 sq. in.

A6209 Foam Drsg. <= 16 sq in. w/o border

A6210 Foam Drsg. > 16 <= 48 sq. in. w/o border

A6211 Foam Drsg. > 48 sq. in. w/o border

A6212 Foam Drsg. <=16 sq. in. w/border

A6213 Foam Drsg. > 16 <=48 sq. in. w/border

A6214 Foam Drsg. > 48 sq. in. w/border

A6215 Foam Dressing Wound Filler

A6216 Non-Sterile Gauze <= 16 sq. in.

A6217 Non-Sterile Gauze > 16 <= 48 sq. in.

A6218 Non-Sterile Gauze > 48 sq in.

A6219 Gauze <= 16 sq. in. w/o border

A6220 Gauze > 16 <= 48 sq. in. w/o border

A6221 Gauze > 48 sq. in. w/o border

A6222 Gauze <= 16 in NO w/Sal w/o B

A6223 Gauze > 16 <= 48 in. NO w/Sal w/o B

A6224 Gauze > 48 in NO w/Sal w/o B

A6228 Gauze <= 16 sq. inWater/Sal

A6229 Gauze > 16 <=48 sq. in. Water/Sal

A6230 Gauze > 48 sq. in. Water/Sal

A6234 Hydrocolld Drg <= 16 w/o Border

A6235 Hydroccolld Drg > 16 <= 48 w/o Border

A6238 Hydrocolld Drg > 16 <= 48 w/Border

A6240 Hydrocolld Drg Filler Paste

A6241 Hydrocolld Drg Filler Dry

A6242 Hydrogel Drg <= 16 in. w/o Border

A6243 Hydrogel Drg > 16 <= 48 w/o Border

A6244 Hydrogel Drg > 48 in. w/o Border

A6245 Hydrogel Drg <= 16 in. w/Border

A6246 Hydrogel Drg > 16 <= 48 sq. inc. w/Border

A6247 Hydrogel Drg > 48 sq. in. w/Border

A6248 Hydrogel Drsg Gel Filler

A6250 Skin Seal Protect Moisturizer

A6251 Absorpt Drg <= 16 sq. in. w/o Border

A6252 Absorpt Drg > 16 <= 48 sq. in. w/o Border

A6253 Absorpt Drg > 48 sq. in. w/o Border

A6254 Absorpt Drg <= 16 sq. in. w/Border

A6255 Absorpt Drg > 16 <= 48 sq. in. w/Border

A6256 Absorpt Drg > 48 sq. in. w/Border

A6257 Transparent Film <= 16 sq. in.

A6258 Transparent Film > 16 <= 48 sq. in.

A6259 Transparent Film > 48 sq. in.

A6260 Wound Cleanser Any Type/Size

A6261 Wound Filler Gel/Paste/oz

A6262 Wound Filler Dry Foam/gram

A6263 Non-Sterile Elastic Gauze/yd

A6264 Non-Sterile No Elastic Gauze

A6265 Tape per 18 sq. in.

A6266 Impreg. Gauze No H2O/Sal/Yard

A6402 Sterile Gauze <= 16 sq. in.

A6403 Sterile Gauze > 16 <= 48 sq. in.

A6405 Sterile Gauze > 48 sq. in.

A6406 Sterile Non-Elastic Gauze/yd

E0100 Canes; Wood

E0105 Walkane

E0159 Brake for Wheeled Walker

E0370 Air Pad Elevator for Heel

E1340 Repair for DME, per 15 min.

K0417 Mech. Infus. Pump Sht. Trm Drug

K0419 Drainable Plastic Pch w/Fcplt

K0420 Drainable Rubber Pch w/Fcplt

K0421 Drainable Plastic Pch w/o Fcplt

K0422 Drainable Rubbe Pch w/o Fcplt

K0423 Urinary Plastic Pch w/Fcplt

K0424 Urinary Rubber Pch w/Fcplt

K0425 Urinary Plastic Pch w/o Fp

K0426 Urinary Hvy Plastic Pch w/o Fp

K0427 Urinary Ruber Pouch w/o Fp

K0428 Ostomy Faceplt/Silicone Ring

K0429 Skin Barrier Solig Ext Wear

K0430 Skin Barrier w/Flang Ex Wear

K0431 Closed Pouch w/St Wear Bar

K0432 Drainable Pch w/Ex Wear Bar

K0433 Drainable Pch w/St Wear Bar

K0434 Drainable Pch Ex Wear Convex

K0435 Urinary Pouch w/Ex Wear Bar

K0436 Urinary Pouch w/St Wear Bar

K0437 Urine Pch w/Ex Wear Bar Conv

K0452 Wheelchair Bearings

L2039 KAFO, Plastic, Medlat Rotat Con

L2430 Long Leg Braces for Hemophiliacs, BI

L2755 Carbon Graphite Lamination

L3956 Add Joint Upper Ext Orthosis

L4205 Ortho VC Repair per 15 min

L4390 Replace Multi-Podus Splint

L4392 Replace Ankle Contrc Splint

L4394 Replace Foot Drop Splint

L4396 Ankle Contracture Splint

L4398 Foot Drop Splint Recumbent

L5814 Add Endoskel Knee-Shin Single Axis

L5987 Shank Ft. w/Vert Load Pylon

L7520 Repair Prosthesis per 15 min.

We appreciate your cooperation and assistance in implementing these changes.  If you have any questions concerning these changes, you may contact the Unisys Prior Authorization Unit at 1-800-488-6334.

Clarification of Global Surgery Period Policy

It has been brought to our attention that there is some confusion regarding the Global Surgery Period policy and when visits may be billed separately from the GSP procedure.

Visits should be billed separately ONLY IF THE DIAGNOSIS FOR THE VISIT IS TOTALLY UNRELATED TO THE DIAGNOSIS OF THE GSP PROCEDURE.  If the diagnosis/reason for the visit is in any way related to the GSP procedure, a visit should not be billed separately.

Please be sure you are following this policy when billing for procedures reimbursed under the Global Surgery Period.  

Clarification on Vaginal and Caesarian Deliveries

It has been brought to our attention that some physicians are billing for admit and discharge services in conjunction with delivery codes 59410 and 59515.

Please note that this practice is contrary to Louisiana Medicaid policy as stated on page 21-2 of the Physician Services Manual and that payments shall be recouped.

The fee for delivery (59410 or 59515) includes inpatient hospital visits occurring both before and after delivery.

This policy is applicable to all other payable delivery codes.  

Reminder to All Providers

It has always been Louisiana Medicaid policy that Unisys staff is not allowed to change any information on a provider�s claim form.  We want to remind providers of this policy and use this avenue to again inform you that if changes are required on a claim before it can be resubmitted, you must make those changes and resubmit the claim.  Please do not ask Unisys staff to make any changes on your behalf.  Thank you.