Beyond 2000: The Unveiling of DHH's Plan for the 21st Century LADUR Education Article
Warning to Physicians Notice to Anesthesiologists: Delivery Codes
Notice to Physicians and KIDMED Clinics Notice to Physicians: Duplicate Claims
Five Prescription Limit Rescinded The Medicaid Dental Program
Multiple Surgical Procedures: Expediting Correct Payment APRN's Granted Limited Prescriptive Authority
Attention Pharmacy Providers: Miscoded NDC Numbers Reimbursement for Amphetamines
Notice to Providers: Code J9388 in Non-Pay Status Notice to Certified Nurse Practitioners: Vaccine Codes

Requirements for Receiving Glucose Monitors

Beyond 2000:  The Unveiling of DHH's Plan for the 21st Century

Department of Health and Hospitals Secretary Bobby Jindal recently introduced a far-reaching, innovative health care reform plan for the state of Louisiana.  This plan is designed to produce healthier citizens, to give the elderly and disabled more choices for community living, to help the uninsured buy health insurance, and to convert charity hospitals into "centers of excellence."  Secretary Jindal's plan, unveiled this fall, is aptly titled "Beyond 2000."

Governor Mike Foster commented at a recent news conference, "I am impressed with this plan.  It deals with the issue of health care comprehensively, it considers all citizens and their needs, and it sets an ambitious course for us to fundamentally restructure the state's role in health care as we move into the 21st Century."

According to Secretary Jindal, Louisiana must explore new ways to better care for nearly 800,000 citizens who are served by Medicaid over the course of each year.  Louisiana Medicaid recipients receive expensive health care services, but they suffer from higher incidences of preventable diseases.  Secretary Jindal's new reform plan addresses these concerns.

"Beyond 2000" has three general themes that set the course for Louisiana Medicaid for the coming years.  They are:  fiscal restraint and control; service quality; and accountability.  Secretary Jindal says the state is already trying new ways of restructuring our health care system, improving health outcomes, and moving decision-making closer to communities.  For example, the Capital Area Healthcare District is governed by a local citizens board, to which about $25 million annually will be redirected from the state to provide outpatient services for public sector clients in the Greater Baton Rouge area.  Two other options - managed care and vouchers - will also be explored for citizens on Medicaid.  In fact, by the time this Provider Update has been published, a managed care pilot program will be announced.

"Beyond 2000" sets three main goals for Louisiana's public health care system:

  • Ensuring high-quality health care services for the indigent, the disabled, the working poor, and others

  • Controlling health care spending by focusing on primary and preventive care;

  • Developing Louisiana as a Southern regional center for excellence for medical education.

The strategic plan of "Beyond 2000" translates the above three goals into four primary objectives:

  • Promoting healthier citizens;

  • Strengthening the safety net for the uninsured;

  • Providing consumer choice for the elderly and the disabled;

  • Reforming charity hospitals.

Some of the specific action item steps recommended by Secretary Jindal to accomplish the goals and objectives noted above are on the following page.

The Department's goals are attainable with the same high level of patient care and provider support is has always received from the medical community.  We thank you again for making our Medicaid programs serve the citizens of Louisiana.

Tom Collins
Director, BHSF

Secretary Jindal recommends the following action steps to achieve the goals and objectives of "Beyond 2000."

"Providing the Medicaid population with appropriate clinical care at reasonable costs" 

  • Place Medicaid recipients in direct and lasting relationships with primary care doctors to ensure continuity and quality of care.

  • Set goals for health outcomes (i.e., immunizations, screenings), coordinate health services among providers, and measure the progress of meeting those goals.

  • Implement point-of-sale and lock-in pharmacy programs to reduce misuse.

  • Pilot managed care / voucher program for a maximum of 50,000 Medicaid recipients and expand these programs to cover 240,000.

  • Enroll 80 percent of the non-elderly and non-disabled Medicaid population in private insurance plans.

"The charity hospital system must be a national model of excellence medical education"

  • Protect the interests of Tulane, Ochsner, and LSU.

  • Focus specialty education for students at regional centers.

  • Offer high quality and effective services to the uninsured.

  • Operate on predictable and reasonable budgets.

  • DOA approval or expended or new services.

  • Coordinate services with primary care providers to avoid duplication and improve quality of care.

  • Enlist private partners to share financial responsibility and improve purchasing, staffing, and billing.

  • Let charity hospitals earn and keep revenues from fees, third party recoveries, and cost-savings.

  • Integrate with local communities, sharing patients and resources with local hospitals to take advantage of local capacity and to minimize transportation costs and inconvenience.

"Providing more comprehensive and planned coverage for the uninsured"

  • Modify and activate the Department of Insurance's LA Health plan to provide basic health insurance coverage to low-income workers.

  • Expand the state catastrophic insurance plan to help families facing overwhelming expenses and illnesses.

  • Encourage insurance companies to offer basic health plans for small businesses.

  • Offer tax credits to employers where they purchase insurance and health care.

  • Allow the uninsured to pay sliding premiums for access to Medicaid managed care or voucher systems.

  • Convert part of disproportionate share dollars to help pay health insurance premiums for the uninsured.

  • Offer access to health care plans for the uninsured, focusing on those up to 200 percent above the poverty level.

"Serving more disabled and elderly citizens; offering them consumer choice"

  • Expand the number of elderly and disabled who are offered waivers to live in the community.

  • Inform clients about the full range of services available for community living.

  • Offer 100 highest-functioning citizens with developmental disabilities in public facilities the option to move to less restrictive environments.

  • Freeze growth at public facilities while improving staff ratios and quality of care for residents.

  • Enhance quality assurance monitoring and enforcement.

  • Pilot multi-parish management of outpatient services.

Louisiana Drug Utilization Review (LADUR) Education

Advances in the Management of a Peptic Ulcer Disease


-Helicobacter pylori (H. pylori) has been implicated as a causative factor in cases of duodenal ulcer, gastric ulcer, and chronic active gastritis.

-The effective management of peptic ulcer disease involves the prevention of recurrent episodes through the eradication of H. pylori.

-There are multiple accepted therapies in the eradication of H. pylori in peptic ulcer disease.

"Disease Management" (DM) may be defined as "a comprehensive approach to improving patient outcomes and lowering costs in key disease categories" (Andjuar 1996).  As such, disease management in Louisiana's Medicaid Drug Program includes a number of interrelated components including:  a) an understanding of each disease state along with associated diagnostic and therapy costs; b) treatments focusing on these diseases and their sequelae; and c) comprehensive patient and provider educational methods.  These and other DM components are the hallmarks of integrated programs focusing on managing diseases instead of simply treating underlying symptoms (Saltiel 1996).  Louisiana's Department of Health and Hospitals has instituted a disease management component of a broader pharmacy benefits management system that will focus on several disease states, including peptic ulcer disease.  Peptic ulcer disease includes gastroesophageal reflux disease (GERD) and gastric and duodenal ulcer.  Gastric and duodenal ulcer disease together are referred to as peptic ulcer disease.

This article focuses on the following components of the disease management effort for peptic ulcer disease and antisecretory medications.

-      The impact of Helicobacter pylori (H. pylori) as a causative agent in peptic ulcer disease, and the role of detection and eradication of this microorganism in the management of these diseases;

-      The contribution of side effects of nonsteroidal anti-inflammatory (NSAIDs) therapy as a causative factor in peptic ulcer disease; and,

-      The pharmacoeconomic impact of the chronic use of antisecretory agents in situations where alternate therapies may be more appropriate.

The potential impact on therapies and economic outcomes of appropriate therapeutic alternatives in the treatment of peptic ulcer and related disorders is clear.  Four of the top ten drugs (in terms of both number of prescriptions and in dollars spent) in Louisiana in 1995 were in the antisecretory drug category, and these agents were primarily used for the treatment of peptic ulcers and related diseases.  These drug categories represent nearly 10% of the Medicaid Drug Program budget and include the widely prescribed histamine2 receptor antagonists (cimetidine, famotidine, nizatidine, and ranitidine) and proton pump inhibitors (lansoprazole and omeprazole).  The effectiveness of these agents as palliative treatments for these related disorders is amply demonstrated by the wide usage of these antisecretory agents in patients exhibiting a variety of symptoms.  These antisecretory drugs increase the gastric pH (reducing its acidity) thereby allowing ulcers to heal through the body's physiological repair mechanisms.

Causes of Peptic Ulcer Disease
Our understanding of the role of H. pylori as a causative factor in peptic ulcer disease has grown in recent years.  Recent recommendations from the National Institutes of Health have focused on antibiotic therapy to manage patients suffering with peptic ulcer disease.  These advances in our knowledge regarding causative factors have dramatically altered our focus regarding both diagnostic testing and treatment choices.  The evidence is substantial, and the pharmacoeconomic implications are obvious:

-      H. pylori has been implicated as the causative factor in more than 95% of cases of duodenal ulcer, 70% of cases of gastric ulcer, and 70% to 100% of the cases of chronic active gastritis.

-      Simple eradication of H. pylori infections in affected patient populations could result in substantially lower rates of recurrence of peptic ulcer disease, and thus a resultant marked reduction in treatment costs.

-      Antibiotic treatment regimens are relatively short in duration (one to two weeks) and provide a cure rather than simply symptomatic treatment.

-      Less than 1% of the cases are due to hypersecretory conditions such as the Zollinger-Ellison Syndrome.

Complications (side effects) from NSAID therapy represent a second leading cause of gastrointestinal tract disorders and related problems.  These problems are largely avoidable with simple monitoring of the patients and their therapeutic regimen.  This is especially true in certain vulnerable populations (patients with renal insufficiency, geriatric patients, and those patients with underlying gastrointestinal tract disorders).

Recurrence of Peptic Ulcer Disease
Another major factor that increases costs associated with antisecretory therapy (both histamine2 receptor antagonists and proton pump inhibitors) is related to the failures of these agents to affect H. pylori.  While these drugs provider symptomatic relief during extended therapy, cessation of treatment usually results in a recurrence of the H. pylori infection and associated symptoms.  The costs associated with recurrences are avoided when patients are treated with appropriate antibiotics.  Table 1 reflects current antibiotic therapies in use today to eradicate H. pylori.  When these regimens are adequately employed, the need for additional antiulcer therapies can be avoided.

Combating Helicobacter Pylori Infection
There has been a plethora of discussion in the medical literature about the best regimen to use in order to eradicate the H. pylori bacteria, and additional alternatives continue to emerge.  The National Institutes of Health Consensus Statement recognizes the value in eliminating H. pylori as a causative agent as appropriate in the treatment of ulcers.  In their statement, the NIH also acknowledged a variety of regimens as effective in this treatment.

Table 1 presents a synopsis of recommended regimens and the efficacy of each in the eradication of H. pylori.  Please note that the agents and doses within each regimen are not necessarily interchangeable.  There is NO single correct therapy and there may be different versions of the listed therapies as well.  Consideration of H. pylori as a potential cause for symptoms of peptic ulcer disease may be the most appropriate choice at this time.  Testing for H. pylori includes gastroscopy with biopsies, serologic testing, and potentially breath tests.  The choice of tests and the conditions of testing will be the subject of later educational interventions.  However, an appropriate determination of H. pylori as the potential cause of symptoms should lead to the most appropriate treatment.













2 tabs 4x day


250mg 2-3x day


500 mg 4x day


20mg 2x day

1 to 2 Weeks 94 - 98%




2 tabs 4x day


250mg 2-3x day


500 mg 4x day

(H2RA)4 1 to 2 Weeks 86 - 90%

88 - 96%


2 tabs 4x day


250mg 2-3x day


500mg 3-4x day

  1 to 2 Weeks 75 - 81%

80 - 94%


2 tabs 4x day


500mg 3x day


500 mg 4x day

  1 to 2 Weeks >90%

2 tabs 4x day


500mg 3x day


500mg 3-4x day

  1 to 2 Weeks >90%

2 tabs 4x day


500mg 3x day


20mg 2x day

8 days1 80%
  RBC5 400mg

2x day


500mg 3x day

    2 Weeks 82 - 94%




500mg 2-3x day


250mg 2x day


20mg 2x day

1 to 2 Weeks 85 - 91%

500mg 2x day


1 gm 2 x day


20mg 2x day

1 to 2 Weeks 80 - 95%

500mg 2-3x day


1 gm 2x day


20mg 2x day

1 to 2 Weeks 77 - 86%




500mg 3x day


40mg daily

2 Weeks 54 - 79%

500mg 3x day


40mg daily

2 Weeks 83%




500mg 2-3x day


750mg 3x day

    2 Weeks >85%

500mg 3x day


500mg 2x day

    2 Weeks >90%



1.      This regimen includes bismuth and clarithromycin for 1 week, plus omeprazole for 8 days.

2.      Bismuth subsalicylate (such as Pepto-Bismol�).

3.      Separate bismuth and tetracycline dosages by at least two hours.

4.      Helidac� therapy (Proctor & Gamble) in which bismuth and tetracycline are taken together plus H2RA.

5.      Ranitidine bismuth citrate (Tritec� - Glaxco Wellcome).


Adapted from table appearing in the Pharmacists Letter by Veronica Moriarty, Pharm.D.

If diagnostic testing indicates H. pylori eradication as a desired therapeutic alternative, the use of combination antibiotics with or without bismuth, plus the inclusion of an antisecretory agent represents best current therapy.  The optimal therapeutic regimen is not year clear, though bismuth plus metronidazole (or clarithromycin) and tetracycline (or amoxicillin) with or without an antisecretory agent have become accepted therapy.  The recent release of Helidac� and Tritec� may provide the appropriate combinations of therapy required for H. pylori eradication.

Although recent studies seem to indicate that the empiric treatment of H. pylori infected patients with antibiotics may make pharmacoeconomic sense (Fendrick 1995), the increase resistance that may result and the potential for side effects associated with such as approach should be carefully considered.  It also should be pointed out that non-ulcer dyspepsia does not respond to antibiotic therapies (Kozol 1996).

Decreasing Problems with NSAID Therapy
Many GI problems in patients taking NSAIDs can be prevented by closely monitoring patients who are vulnerable.  This group includes those who have a diagnosis related to renal insufficiency, who are older than 60, or who have had a previous history of gastric ulcer disease of GI bleeding.  This situation occurs commonly and causes increased (and many times unnecessary) medical and pharmaceutical costs to the Louisiana Medicaid Drug Program as well as increased health risks to the patients.  Appropriate monitoring of patients on NSAIDs can significantly reduce associated side effects and decrease medical costs.  In certain circumstances, it may even be prudent (both medically and economically) to consider prescribing prophylactic therapy (such as micoprostol or concurrent use of an antisecretory drug) in combination with NSAIDs in "at-risk" patients who absolutely need an anti-inflammatory agent. 

Chronic Therapy With Antisecretory Agents
Additional cost savings and enhanced therapy may be seen when patients receive chronic therapy only for periods of time associated with proven beneficial results.  This is generally no more than eight weeks of therapy except in certain specific indications, e.g., GERD and certain hypersecretory conditions (Zollinger-Ellison Syndrome) and gastrointestinal tract disorders (Barrett's Esophagitis).  The use of the most cost effective prescription alternatives, or the recommendations for nonprescription dosages of existing agents are also suitable cost saving alternatives when appropriate.  It is difficult to rationalize the benefits of use of prolonged antisecretory therapy except with specific therapeutic indications. 

The effective management of peptic ulcer disease involves the prevention of recurrent episodes through the eradication of H. pylori.  This infection is generally curable in patients where NSAID therapy is not contributing to the gastrointestinal tract problems.  Only a small number of patients, who are not cured by one of the recommended H. pylori regimens, are candidates for long term therapy.  Whenever patients present symptoms of peptic ulcer disease for a second (or more frequent) time within a 12-month time period, therapy with antibiotics aimed at eradication of H. pylori should be instituted in combination with an appropriate antisecretory drug.  The cost effectiveness of such a treatment protocol should be balanced with the potential for drug resistance or possible drug-related side effects.  In patients on multiple or chronic NSAID therapy, a key to effective management may be careful monitoring and the use of lower doses of shorter-acting agents. 

References Available Upon Request

Policy Notes:  Physician Providers

Warning to Physicians

Louisiana Medicaid's Surveillance and Utilization Review (SURS) Unit has uncovered a disturbing billing practice in which entities not enrolled as Medicaid providers are using physicians' Medicaid numbers in order to submit billing for their services.  SURS has found that some physicians have unknowingly become involved in this fraudulent billing practice, and wants to raise physician awareness of this practice so that physicians may not become liable for this billing.

This scam is put into motion when a non-Medicaid enrolled entity hires an enrolled physician provider, and then uses that physician's Medicaid number for billing.  These fraudulent billings are detected by SURS audits, which find unusual, aberrant billing patterns; for example, inappropriate testing maybe detected.  Physicians risk being drawn into a long, complicated fraud investigation and the unenrolled entities risk criminal prosecution.  Please be careful with your Medicaid number.  If you are aware of a suspicious practice, please call our fraud line at 1-800-488-2917.

Charles Lucey, MD, JD, MPH, and Bob Patience, DHH SURS Manager

Notice to Anesthesiologists:  Delivery Codes

In 1996 CPT, there are new "delivery after previous Caesarean delivery" codes (codes 59610 through 59622).  This notice is to serve as clarification of the codes and modifiers to be used when billing anesthesia for these procedures.

If billing for an epidural performed for a vaginal delivery (59610, 59612, or 59614), bill code 62279 with modifiers AA, AI, AE, 24, or 25 (the same code and modifiers that are used to bill for epidural anesthesia for vaginal delivery code 59410).  If billing for maternity related anesthesia for Caesarean Section, bill code 59618,  59620, 59622 with modifiers AA, AI, AE, 24, or 25 (the same modifiers that are used with code 595150.

In addition to the correct modifier, any provider who uses procedure code 62279 must also use the correct diagnosis code to ensure payment.  Providers should use diagnosis code 650-659, 669.5, or 669.6.  No other digits in the 5th place should be accepted.  On diagnoses 669.5 and 669.6, only digits 0 and 1 should be in the 5th place.

Notice to Physicians and KIDMED Clinics

We recently learned that on September 9, 1996 the Office of Public Health distributed the flu vaccine (CPT code 90724) to all Vaccines for Children (VFC) enrolled providers who requested it.  Therefore, since September 9, 1996, CPT code 90724 has been reimbursed at a fee of $9.45 for the administration-related costs only, the same as other vaccinations provided through the VFC Program.  If you received a payment greater than $9.45 for this vaccine for date of service September 9, 1996, or thereafter, the difference in payment will be recouped in the near future.

Notice to Physicians:  Duplicate Claims

We have found duplicate claims payments where two different billing providers were paid for the same services rendered by one attending physician.  Where payment was made to the attending and to a group, the payment to the attending was voided.  Where payment was made to two groups, the second claim paid was voided.  These claims received EOB message 849 which stated "Already paid same attending different billing provider."

Five Prescription Limit Rescinded

The Department of Health and Hospitals, Bureau of Health Services Financing, published an emergency rule establishing a limit of five prescriptions per month in the Pharmacy Program effective for dates of service beginning January 1, 1997.

Please be advised that the Department has determined that it is necessary to rescind this emergency rule.  Therefore, this emergency rule will not be implemented effective January 1, 1997.

The Medicaid Dental Program

By Dr. Robert Barsley

Dentistry is a small but important part of the health care system in general and also in Medicaid of Louisiana.  The EPSDT Dental Program provides comprehensive coverage of basic dental needs to recipients under the age of 21.  The Adult Denture Program provides complete denture services to recipient older than 21 who no longer have any teeth.  Together, these programs treated over 160,000 recipients in the last fiscal year at a cost of $26,000,000.00.  Two-thirds of Louisiana's dentists are enrolled as providers and some 65% of these were active in the program within the last 12 months.

In fiscal year 1992-93, the budget for EPSDT and adult dental services slightly exceeded $29,000,000.00, and has decreased annually since that time.  Virtually all Adult Denture Program services require prior authorization as do many of the non-emergency EPSDT Dental Program services.  Dental consultants at the LSU School of Dentistry in New Orleans handle more than 50,000 prior authorizations issued each year.

The state, through the Office of Maternal and Child Health, has once again funded Dr. Jim Sutherland as State Dental Officer.  He is a commissioned officer of the National Public Health Service.  Along with input from several sources (including Medicaid), his office is conducting a reassessment of the oral health needs in Louisiana.

One of his first findings has been the less than optimal state of the community water fluoridation program in this state.  Today, less than 50% of Louisiana citizens receive the well-documented benefits of community water fluoridation.  Monroe, Alexandria, Baton Rouge, and Lafayette are some of the areas without fluoridation.  If you have questions about fluoridation in your area, Dr. Sutherland can be reached at (504) 568-7706.

The Medicaid Dental Program is also attempting to address the difficulties encountered by older recipients who require dental treatment as a medically necessity adjunct to medical treatments such as organ transplants.  Dental disease can be a complicating factor in such cases.  We are attempting to identify a methodology to ensure that such recipients are cared for in a timely manner and that the dental provider is reimbursed.

Please feel free to call the dental consultants at (504) 619-8589 if you have questions about these or other facets of the Dental Program operated by Medicaid of Louisiana.

Dr. Robert Barsley is a graduate of LSU School of Dentistry and has been a member of the facility since 1982.  He has worked with the Medicaid Dental Program since 1991 and was appointed Director in 1994 upon the retirement of Dr. Harry Leveque.

Multiple Surgical Procedures:  Expediting Correct Payment

When more than one surgical procedure is submitted for a recipient on the same date of service, the claim is always evaluated by the Unisys Medical Review Unit, regardless of the method or timing of claim submittal.

Listed below are suggestions for facilitating correct payment:

1.     All attachments should be clear, easy-to-read copies.

2.     Correctly date all operative reports.

3.     Use specific, appropriate diagnostic codes.

4.     Submit requested documentation at your earliest convenience so that correct payment can be quickly determined.

5.     Refrain from submitting two or more identical HCFA 1500 forms at the same time.  Bill all procedures performed under the same anesthesia session on the same HCFA 1500 form.  Use correct modifiers and attach operative report and any other pertinent documents with the claim.  Failure to do this may slow payment and/or result in time consuming voids or adjustments.

6.     Assistant surgeons should always append an 80 modifier on each claim line.  Assistant surgeons are not required to use the 51 modifier for secondary procedures.

Professional Services Training:  Medicaid Issues for 1996 offers the following concise guidelines.

Billing Multiple and Bilateral Procedures
When billing multiple surgical procedures while under the same anesthesia session, the correct procedure is to bill the major procedure with no modifier and to put a 51 modifier on any or all additional procedures.

When billing bilateral procedures, the correct procedure is to bill the CPT code for the procedure done with a 50 modifier on one line with total charges on that line.

Billing the CPT code on one line with no modifier and on a second line with a 50 modifier is incorrect.  If billed on two lines as stated above, the line with the unmodified CPT code will pay and the line with the 50 modifier on the CPT code will be denied 987 - rebill on adjustment.  The provider will then have to submit an adjustment using the CPT code with a 50 modifier.  The paid line is the line which would need to be adjusted (page 56). 

Unlisted Procedures
Providers should not bill unlisted procedure codes when there are listed codes that describe the service. 

An example is the use of code 37799 to bill for insertion of catheters.  Code 36800 - 36820 and other procedure codes cover cannula/catheter insertion.

Claims submitted under unlisted procedure codes are subject to manual review.  If a CPT code exists that describes the service that was billed as an unlisted procedure code, the claim will deny.

Providers are required to attach operative reports each time an unlisted procedure code is billed.

If you have any questions concerning coding, please contact the American Medical Association at (312) 464-4737 or 1-800-262-3211 (page 61).  We want to expedite your claims; please help us to help you.

Unisys Medical Review Unit

Policy Notes:  Pharmacy Program

APRNs Granted Limited Prescription Authority

Effective November 15, 1996, Advanced Practice Registered Nurses (APRN) were granted limited prescriptive authority and the right to distribute free samples in a limited demonstration project in accordance with Act 629 of the 1995 Legislature.

The Board of Nursing promulgated the necessary rule in the October 20, 1996 issue of the Louisiana Register.  Approximately thirty-three APRNs have been certified to have limited prescriptive authority.  In accordance with the Louisiana laws and regulations, the Board of Nursing has issued APRN certificate numbers to nurses certified to participate in the demonstration project and have prescriptive authority.

Prescriptions written by an APRN must contain the following information:  1) the name, office address, telephone number, "RN" designation, and clinical specialty area of the APRN; 2) the collaborating physician's name shall be preprinted, stamped, or handwritten on the prescription form and shall be clearly distinguishable; 3) the date the prescription is written; 4) the name, home address, and telephone number of the patient; 5) the full brand name of the drug and directions for its use; 6) each prescription written by an APRN pursuant to authority granted under these rules shall bear the legend "DEMONSTRATION PROJECT (per R. S. 37: 1031-1035"; 7) an APRN with limited prescriptive authority shall retain a duplicate or copy of each prescription written and issued to patients; and 8) prescriptions written by an authorized APRN with the abbreviation for the applicable category of advanced nursing practice, and the identification number assigned by the Board of Nursing.

The Bureau of Health Services Financing will reimburse for prescriptions written by APRNs in accordance to their rules and regulations.  We require that pharmacists use the APRN's Medicaid provider number when billing on a pharmacy claim form.  In the event that an APRN does not have a Medicaid provider number, the pharmacist should contact the Bureau's Provider Enrollment Unit (504-342-9454) for the provider number of the APRN or for the issuance of a prescriber only number for use on the claim form's prescribing provider information.  Medicaid will require the APRN's number rather than the collaborating physician's Medicaid provider number.

Attention Pharmacy Providers:  Miscoded NDC Numbers

We have been notified by Bayer Laboratories through the submission of drug utilization rebate data that pharmacies are billing and getting reimbursed for NDC numbers which are miscoded or not on the manufacturer's master file.

Please be advised that these Bayer Laboratories drug products have been coded to non-payable status:


Please ensure when billing drug products that you use the NDC from the package from which you are dispensing.  We will continue to inform you of drug products which are considered obsolete.

Reimbursement for Amphetamines

Effective for services beginning October 18, 1996, the Bureau of Health Services Financing will begin reimbursing for the following amphetamines for medically approved indications other than when prescribed as an anorexiant for weight reduction.  When amphetamines are prescribed as an anorexiant, they will continue to be non-reimbursable.  In order for amphetamines to be reimbursed by the Medicaid Program, a hard copy claim form must be completed with an attachment to the hard copy claim.  The prescription must be hand-written with the prescribing physician's written statement of the medically accepted indication for the drug which appears in peer-reviewed medical literature or which is accepted by one or more of the following compendia:  the American Hospital Formulary Service-Drug Information, the American Medical Association Drug Evaluations and the United States Pharmacopoeia-Drug Information.

For claim acceptance, the prescriber must include a copy of the prescription with the prescribing physician's statement of the medical indication, a statement written and signed by the prescribing physician, or a typed statement that must be signed by the prescribing physician.  The indication must not be used as an anorexiant or as an adjunct in a weight reduction program.  Non-amphetamine anorexiants remain non-covered items.  When amphetamines are prescribed for attention-deficit disorder or narcolepsy, they will only be reimbursed for recipients from ages 3 to 21.

Louisiana Maximum Allowable Costs will be established for the following drugs:

Generic Description                                LMAC         Effective Date

Dextroamphetamine sulfate tablet 10mg      0.33600        11-1-96

Dextroamphetamine sulfate tablet 5 mg       0.18815        11-1-96

Only those drugs manufactured by companies participating in the rebate agreement are payable.

Policy Notes:  All Providers

Notice to Providers:  Code J3988 in Non-Pay Status

Effective with date of service November 1, 1996, code J9388 - Etoposide, 20mg/ml - was placed in non-pay status.  The codes to bill in its place are as follows:

         J9181, Etoposide, up to 10 mg, fee $11.23

         J9182, Etoposide, up to 100 mg, fee $112.35

Notice to Certified Nurse Practitioners:  Vaccine Codes

The following codes for the Hepatitis B vaccine have been added to the list of codes payable to nurse practitioners, effective with date of service 1-1-96.  Remember, immunizations are reimbursed to nurse practitioners at 100% of the fee on file. 

         90744 (Hepatitis B Vaccine - under 11 years), fee $9.45

         90745 (Hepatitis B Vaccine - 11-19 years), fee $9.45

         90746 (Hepatitis B Vaccine - 20-21 years), fee $9.45

Requirements for Receiving Glucose Monitors

Glucose monitors are provided to Medicaid eligible recipients who are insulin-dependent, insulin-requiring, or gestational diabetics.

The prescription or letter for the blood glucose monitor must state that:

1.     The recipient is an insulin-dependent or insulin-requiring diabetic, or the recipient's diagnosis is gestational diabetes;

2.     The recipient or someone on his/her behalf can be trained to use the monitor correctly; and

3.     The monitor is for home use.

Diabetic supplies for insulin-dependent, insulin-requiring, or gestational diabetes are available through the Pharmacy Program.  All insulin-dependent, insulin-requiring, or gestational diabetic Medicaid recipients must present a physician's prescription and current Medicaid card to pharmacies which accept Medicaid for the following diabetic supplies:  disposable insulin syringes, blood glucose monitoring strips, urine ketone monitoring strips, auto-lancet devices, and auto-lancets.  The prescription for disposable syringes must contain the prescribing physician's written statement that the recipient is insulin-dependent or insulin-requiring.