PHARMACY PROVIDERS, PLEASE
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 http://www.lamedicaid.com/.
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
OUTPATIENT HOSPITAL PROVIDERS: PULSE OXIMETRY CLAIMS
Effective with the March 26, 2013 date of processing, outpatient hospital claims for noninvasive ear or pulse oximetry
(CPT code 94760) will be processed through the ClaimCheck clinical editing product, and subject to the same editing
as professional claims. Providers can expect that pulse oximetry claims will be considered integral/incidental to other
allowed services performed on the same date and in most instances will not be separately reimbursed. This update
provides consistency in Medicaid policy among provider types.
For questions related to this information, please contact Molina Medicaid Solutions Provider Services at
(800) 473-2783 or (225) 924-5040.
ATTENTION DURABLE MEDICAL EQUIPMENT PROVIDERS
Please note the DME HCPCS code E1091 (Youth wheelchair, any type) is being discontinued effective 4/30/13.
The appropriate code should be submitted to prior authorization (PA) requests dated 5/1/13 forward.
If you have any questions, please contact Molina Prior Authorization at 225-928-5263 or
Attention Professional Services Providers:
Medical Review Required for CPT Code 64615
Effective with dates of service beginning April 15, 2013, Medical Review is required for Current Procedural
Terminology (CPT) code 64615 (Chemodenervation of muscle(s): innervated by facial...for chronic migraine)
to determine if the following criteria have been met prior to allowing payment. For the treatment to be
reimbursed using this code, documentation must be submitted with the claim that demonstrates that
the patient meets these criteria related to chronic migraine:
- Fifteen or more days of headache or a headache that lasts 4 hours or more per day over 30 days
Please visit http://www.lamedicaid.com for the notice. If you have any questions please contact Molina Provider Relations at (800)473-2783 or (225)924-5040.
Attention Professional Services Providers: Prior Authorization Required for Brentuximab Vedotin
J9042: Brentuximab Vedotin is a new code included in the HCPCS updates for 2013. Effective April 18, 2013, Louisiana Medicaid will require prior authorization for the chemotherapy
drug J9042: Brentuximab Vedotin. Brentuximab Vedotin is a chemotherapy drug used in the treatment of
Hodgkin's lymphoma after failure of an autologous stem cell transplant or failure of at least two multidrug
chemotherapy regimens. Brentuximab Vedotin is also used for treatment of systemic anaplastic large-cell
lymphoma after failure of at least one prior multidrug chemotherapy regimen.
If you have any questions, please contact Molina Provider relations at (800)473-2783 or (225)924-5040.
On March 19, 2013, Judge Brian Jackson issued his Ruling and Order in Joseph Taylor v State of
Louisiana, Through the Department of Health and Hospitals, et al, Civil Action Number 09-1068,
United States District Court, Middle District of Louisiana declaring LAC 50:1.8341-8349 (Pursuit
of the Difference Rule} preempted by existing Federal law to the extent LAC 50:1.8341-8349 permits a
health care provider to recoup the balance of its customary payment from third-party settlement
proceeds after the provider has accepted payment from Medicaid.
In light of Judge Jackson's ruling, it is the position of the Department of Health and Hospitals/Medicaid
Program that medical providers may no longer pursue collection and/or accept payment of the "Difference";
accordingly the "Notification to Louisiana Medicaid" form is no longer being accepted by the Department of
Health and Hospitals/Medicaid Program.
Should you have any questions regarding pursuit of and/or acceptance of payment of the "Difference", please
contact your legal adviser.
Attention Professional Services and Non-Hospital Ambulatory Providers: 2013 HCPCS Update
The Louisiana Medicaid files have been updated to reflect the new and deleted HCPCS codes for 2013.
Providers began to see these changes on the RA of April 2, 2013. Claims denied due to use of the new
2013 codes prior to this update will be recycled once the fee schedules are completed.
Molina is currently updating the Professional Services Fee Schedule on the Louisiana Medicaid Website,
Additionally, the "Assistant Surgeon/Assistant at Surgery Covered Procedures List" under the blue "Claim Check"
icon on the website homepage has been updated to reflect applicable 2013 procedure codes. As a reminder,
"Claim Check" uses the American College of Surgeons (ACS) as its primary source for determining appropriate
assistant surgeon designations.
For questions related to this information, please contact Molina Medicaid Provider Services at
(800) 473-2783 or (225) 924-5040.