RA Messages for August 10, 2009


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

Please note the following changes to Appendix A  

    DRUG                    DOSE         STRG      FUL         EFF      

 CLOBETASOL PROP        AERO FOAM,TOP    0.5%     $2.97960   08/28/09   

 DESIPRAMINE HCL          TABLET         25MG     OFF FUL    08/28/09   

 DESIPRAMINE HCL          TABLET         50MG     OFF FUL    08/28/09   

 DESIPRAMINE HCL          TABLET         75MG     OFF FUL    08/28/09   

 DESIPRAMINE HCL          TABLET        100MG     OFF FUL    08/28/09   

 DESIPRAMINE HCL          TABLET        150MG     OFF FUL    08/28/09   

 DESOGESTREL;ETHIN EST.   TABLET      0.15;0.03MG $1.09500   08/28/09   

 DIVALPROEX SODIUM        CAP.SPRINK     125MG    $0.82100   08/28/09   

 HYDROCORTISONE BUTYRATE  SOLUTION,TOP    1%      $0.37880   08/28/09   

 HYDROMORPHONE HCL        TABLET          2MG     $0.21840   08/28/09   

 LAMOTRIGINE              TAB DISPER      5MG     $0.66090   08/28/09   

 LAMOTRIGINE              TAB DISPER     25MG     $0.69230   08/28/09   

 LAMOTRIGINE              TABLET         25MG     $0.30350   08/28/09   

 LAMOTRIGINE              TABLET        100MG     $0.34670   08/28/09   

 LAMOTRIGINE              TABLET        150MG     $0.38000   08/28/09   

 LAMOTRIGINE              TABLET        200MG     $0.41350   08/28/09   

 METOPROLOL SUCCINATE     TAB.SR 24H    100MG     $1.42380   08/28/09   

 METOPROLOL SUCCINATE     TAB.SR 24H    200MG     $2.26500   08/28/09   

 METRONIDAZOLE            LOTION        0.75%     $1.16950   08/28/09   

 MYCOPHENOLATE MOFETIL    CAPSULE       250MG     $0.52910   08/28/09   

 MYCOPHENOLATE MOFETIL    TABLET        500MG     $1.05800   08/28/09   

 OMEPRAZOLE               CAPSULE DR     40MG     $1.73430   08/28/09   

 RIFAMPIN                 CAPSULE       150MG     $1.47800   08/28/09   

 STAVUDINE                CAPSULE        15MG     $2.25550   08/28/09   

 STAVUDINE                CAPSULE        20MG     $2.34570   08/28/09   

 STAVUDINE                CAPSULE        30MG     $2.49120   08/28/09   

 STAVUDINE                CAPSULE        40MG     $2.68750   08/28/09   


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 www.lamedicaid.com


Effective with date of service September 1, 2008, in addition to the facility fee for the surgery, Louisiana Medicaid will reimburse the ASC for corneal tissue (currently HCPCS code V2785) used in corneal transplant procedures. It is the Department's intent that corneal tissue be reimbursed only when a valid facility fee for the related surgical procedure has been paid to the ASC on the same date of service for the same recipient. As in all circumstances, providers are expected to maintain appropriate records documenting the services billed to Medicaid.

Only those corneal tissue claims for date of service September 1, 2008 and after will be considered for this payment methodology. ASC providers that performed corneal transplants and were paid the facility fee for corneal transplant surgery may now submit claims for the corneal tissue, if applicable, for DOS September 1, 2008 forward. However, to prevent  inadvertent denials in the future, the ASC should bill for both the surgery and the corneal tissue on the same claim. The situation is an exception to current published Non-Hospital ASC policy stating "There should only be one line item per claim form."


Due to a claims processing error, some duplicate Medicare Part B claims were paid in the past. All duplicate claims paid 7/1/07 or after are being voided on the 7/28/09 RA. We regret any inconvenience this processing error may have caused. Please contact Unisys Provider Relations if you have any questions.


Louisiana Medicaid enrolled dental providers are required to update their provider contact information through the www.lamedicaid.com website. The Provider Locator Information link allows providers to update existing contact information and the option to indicate if they are "Accepting New Medicaid Patients," which will then be viewable to the public when using the Provider Locator Tool to locate Medicaid providers. Complete details are located on the www.lamedicaid.com website. Questions about the website may be directed to Unisys Provider Relations at (800) 473-2783 or (225) 924-5040.


Effective with date of service July 1, 2006 forward, Louisiana Medicaid reimburses for cochlear implant post-operative programming codes (current CPT code range 92601-92604). Providers are to adhere to national standards and CPT guidelines when billing for these services. If nationally approved changes occur to these CPT codes at a future date, providers are to follow the most accurate coding available for covered services for that particular date of service, unless otherwise directed. Medicaid payments received by providers for inappropriate services are subject to review, recoupment and sanction. A systematic recycle of claims that originally denied for "procedure/type of service not covered by program" will be completed in the near future. No action is necessary by providers. Notification will be made via remittance advice message when the recycle occurs.


The TAKE CHARGE Program is limited to coverage of family planning services ONLY, and only those services are approved and payable. The approved list of diagnosis codes is available in the documentation for this program online at www.takecharge.dhh.louisiana.gov, and the family planning diagnosis MUST be the primary diagnosis on any claim for TAKE CHARGE recipients. This supports the fact that you are seeing the patient for family planning services and billing Medicaid for those services. If reporting other diagnoses on the claim is appropriate, they should be reported as additional diagnoses. Also, please remember, if services other than the covered family planning services are in order, the recipient should be informed prior to the visit/prior to providing the services that such services are not covered through the TAKE CHARGE Program.