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.


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 1-800-488-6334.

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 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.