If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in Appendix C, available at

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

National Correct Coding Initiative Edits 2013

The Centers for Medicare and Medicaid Services (CMS) has recently released the 2013 quarter one procedure to procedure edits as a part of the mandated National Correct Coding Initiative (NCCI) editing. Included are edits that pair immunization administration codes with preventive medicine codes billed on the same date of service by the same provider. This can result in the preventive medicine code being denied. NCCI long-standing policy and methodology allows payment of both codes in this scenario IF significant, separately identifiable E & M service is provided on the same day and the -25 modifier is appended to the E & M code.

As a result of comments received from the American Academy of Pediatrics and some state Medicaid agencies, CMS has decided to permit states to deactivate these edits should they choose to do so. Per CMS on February 7, 2013, "It is understood that immunizations are commonly administered in conjunction with a comprehensive preventive medicine evaluation and that, when this occurs, both services are payable." It would be expected that all services provided are medically necessary and appropriately documented in the patient record.

Louisiana Medicaid (for fee for service and shared plan claims that process through the Molina claims processing system) will soon be implementing the 2013 quarter one NCCI edits; however, the code pairs specific to preventive services and immunization administration will be deactivated as CMS permits. Doing so aligns with our intent and expectations that appropriate immunizations are to be given at the time of the preventive visit to avoid missed opportunities in both preventive care and immunizations.

Each Bayou Health prepaid plan is required to implement NCCI editing, but may have slightly different implementation schedules and billing policy related to the mandate. It is understood that the prepaid plans will allow appropriate use of modifier-25 if they have activated the code pairs in question. Please contact the plans directly for information specific to their implementation, policies, and any billing instructions.

For questions related to this information as it pertains to legacy Medicaid or Bayou Health shared plans, please contact Molina Medicaid Solutions Provider Services at (800) 473-2783 or (225) 924-5040.


Providers will no longer use the miscellaneous HCPC E1399 for cough stimulating device when requesting prior authorization for this equipment. Providers may submit any outstanding claims with existing prior authorizations using the E1399 for payment; however effective immediately, request for these services must be submitted using the appropriate code.

The appropriate code E0482 has been added to the DME Fee schedule for payment. Also, this procedure code is only payable for members under the age of 21. Reimbursement for this equipment will not be manually priced using E1399.


This is to advise that DHH has posted the procedures necessary to request prior authorization for medical equipment and supplies in emergency situations as a reminder to all providers of durable medical equipment and supplies to the LA Medicaid website at

If you have any questions regarding the procedures please contact Molina Prior Authorization Department at 225-928-5263 or 1-800-488-6334.


Effectively immediately DME providers are being advised to discontinue distributing the Abbott Enteral Therapy Pumps, as DHH has been made aware that Abbott will be discontinuing their line of enteral pumps effective April 31, 2013.

This notice is to also advise that DHH will not be replacing any pumps unless the current pumps are no longer operable. DHH has been advised that supplies for the discontinued pumps are available through Covidien, therefore it is not necessary to replace any pumps that are fully operable.

Also, providers are cautioned not to attempt to retrieve the Abbott pumps from the recipient as the pumps were purchased by DHH and are now the property of the recipients.


The Louisiana Medicaid files are currently being updated to reflect the new and deleted HCPCS codes for 2013. Once completed, a provider notice will be posted and claims that have been denied due to use of the new 2013 codes prior to their addition to our system will be systematically recycled.

Once this process is completed, providers will see claim denials of 2012 codes that are being deleted effective December 31, 2012. Those claims should be resubmitted with the correct 2013 code.

Attention Dental Providers

With the introduction of the Dental procedure D1208 (Topical Application of Fluoride), that was made payable for recipients effective January 1, 2013, the department did a systematic recycle for all denied claims. As a result of this recycle some claims were appropriately denied but were not showing the denied reason. These claims which showed up on the RA dated 3/5/13 are being processed again so that the correct denial will appear on your 3/19/13 RA.


Rate reductions to anesthesia services were incorrectly applied for dates of service July 1, 2012 through July 19, 2012. Rates should have been reduced by 3.7 percent but were reduced by 3.4 percent instead. We are systematically adjusting affected claims to correct the error. These claims will appear on the March 19, 2013 Remittance Advice. Rates for dates of service after July 19, 2012 were correctly reduced by 3.4 percent and are not affected by this adjustment.