PROVIDERS, PLEASE NOTE!!!
If you are unsure
about the coverage of a drug product, please contact the PBM help desk
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.
BILATERAL PROCEDURES: BILLING CLARIFICATION
When billing for bilateral procedures performed
during the same session (unless otherwise directed in CPT), providers
are to use the -50 modifier (Bilateral procedure) with the appropriate
CPT code and place a "1" in the units field of the claim form. The site
specific modifiers 'LT' (Left side) or 'RT' (Right side) may be used on
appropriate CPT codes only when services are performed on either the
right OR the left side. Providers should not use the 'LT' and 'RT'
modifier on the same procedure code instead of the -50 modifier. For
example, during the same session it is not appropriate to use the 'RT'
and 'LT' on CPT procedure code 69436 (Tympanostomy...) when performed
bilaterally. For questions related to this clarification, please contact
Molina Medicaid Solutions Provider Services at (800)-473-2783 or