RA Messages for December 30, 2008


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


         DRUG                                         DOSE             STRGTH             FUL             LMAC                 EFF
ACEBUTOLOL HCL                      CAPSULE             200MG         $0.4613                                   01/12/09
ACEBUTOLOL HCL                      CAPSULE             400MG         $0.6713                                   01/12/09
AMITRIPTYLINE                             TABLET               50MG          $0.0758                                   01/12/09
AMITRIPTYLINE                             TABLET              100MG         $0.1568                                   01/12/09
AMOXICILLIN                               CAPSULE             250MG         $0.0653                                   01/12/09
AMOXICILLIN                               CAPSULE             500MG        $0.1193                                    01/12/09
AMOXICILLIN TRIHYDRATE      SUSP REC          125MG/5ML  $0.0201                                    01/12/09
AMOXICILLIN TRIHYDRATE      SUSP REC          250MG/5ML  $0.0299                                    01/12/09
ATENOLOL/CHLORTHALIDON    TABLET          50MG/25MG   $0.1122                                    01/12/09
ATENOLOL/CHLORTHALIDON    TABLET         100MG/25MG  $0.3068                                    01/12/09
BUSPIRONE HCL                            TABLET                 5MG         $0.0527                                     01/12/09
BUSPIRONE HCL                            TABLET                10MG        $0.0714                                     01/12/09
BUSPIRONE HCL                            TABLET                15MG        $0.1028                                     01/12/09
CARBIDOPA/LEVODOPA              TABLET       10MG/100MG    $0.4043                                     01/12/09
CARBIDOPA/LEVODOPA              TABLET       25MG/100MG    $0.4688                                     01/12/09
CARISOPRODOL                            TABLET             350MG         $0.0851                                     01/12/09
CEFUROXIME AXETIL                   TABLET              250MG        $0.5513                                    01/12/09
CEFUROXIME AXETIL                   TABLET              500MG        $1.0665                                    01/12/09
CLOMIPRAMINE HCL                   CAPSULE             25MG         $0.3750                                    01/12/09
CLOMIPRAMINE HCL                   CAPSULE             50MG         $0.5036                                    01/12/09
CLONAZEPAM                                TABLET                 0.5MG      $0.0600                                    01/12/09
CLONAZEPAM                                TABLET                 1MG         $0.0780                                    01/12/09
CLONAZEPAM                                TABLET                 2MG         $0.1080                                     01/12/09
CLONIDINE HCL                            TABLET                 0.1MG       $0.1050                                    01/12/09
CLONIDINE HCL                            TABLET                 0.2MG       $0.1410                                    01/12/09
CLONIDINE HCL                            TABLET                 0.3MG       $0.1815                                    01/12/09
FLUOXIDINE HCL                          CAPSULE               10MG       $0.1386                                    01/12/09
FLUOXIDINE HCL                          CAPSULE               20MG       $0.1454                                    01/12/09
FLUOXIDINE HCL                          CAPSULE               40MG       $1.1625                                    01/12/09
FLUOXIDINE HCL                          SOLUTION         20MG/5ML  $0.2250                                    01/12/09
GUANFACINE HCL                        TABLET                 1MG          $0.1242                                    01/12/09
GUANFACINE HCL                        TABLET                 2MG          $0.7011                                    01/12/09
HYDROCORTISONE             CREAM,TOPICAL         1%             $0.0560                                    01/12/09
HYDROCORTISONE             CREAM,TOPICAL        2.5%           $0.1650                                    01/12/09
HYDROCORTISONE              LOTION,TOPIC           2.5%           $0.7500                                    01/12/09
HYDROXYZINE HCL                    SYRUP             10MG/5ML                             OFF MAC         01/12/09
IBUPROFEN                                     TABLET                 400MG     $0.0345                                    01/12/09
IBUPROFEN                                     TABLET                 600MG     $0.0417                                    01/12/09
IBUPROFEN                                     TABLET                 800MG     $0.0638                                    01/12/09
LOVASTATIN                                  TABLET                  10MG      $0.3285                                    01/12/09
LOVASTATIN                                  TABLET                  20MG      $0.4622                                    01/12/09
LOVASTATIN                                  TABLET                  40MG      $0.7922                                     01/12/09
MORPHINE SULFATE              SOLUTION              20MG/ML                            OFF MAC        12/02/08
NYSTATIN                              CREAM,TOPIC         100MU/GM   $0.0990                                    01/12/09
OXYBUTYNIN CHLORIDE            SYRUP                 5MG/5ML  $0.0278                                    01/12/09
OXYBUTYNIN CHLORIDE            TABLET                    5MG      $0.1650                                    01/12/09
SILVER SULFADIZINE             CREAM,TOPIC                 1%      $0.0628                                    01/12/09
SULFACETAMIDE SODIUM    SOL/DROPS,OPH        10%        $0.1690                                      01/12/09
TERAZOSIN HCL                          CAPSULE                  1MG        $0.1425                                    01/12/09
TERAZOSIN HCL                          CAPSULE                  2MG        $0.1425                                    01/12/09
TERAZOSIN HCL                          CAPSULE                  5MG        $0.1425                                    01/12/09
TERAZOSIN HCL                          CAPSULE                 10MG       $0.1425                                    01/12/09
VERAPAMIL HCL                          TABLET                    80MG      $0.0773                                    01/12/09
VERAPAMIL HCL                          TABLET                   120MG     $0.1148                                    01/12/09
ZIDOVUDINE                                 TABLET                   300MG     $0.9110                                    01/12/09
ZONISAMIDE                                CAPSULE                  25MG      $0.1031                                    01/12/09
ZONISAMIDE                                CAPSULE                  50MG      $0.2112                                    01/12/09
ZONISAMIDE                                CAPSULE                 100MG     $0.4998                                    01/12/09

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 January 1, 2008 forward, Louisiana Medicaid reimburses CPT codes 99289 and 99290 (Critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less;...). Policy regarding these services can be found on the Medicaid website homepage, www.lamedicaid.com, and via the link there to "New Medicaid Information".


Effective with date of service August 6, 2008, reimbursement rates for select immunization administration codes (90465, 90467, 90471, and 90473) have been updated utilizing the same reimbursement methodology as used for the Professional Services 2008 reimbursement rate changes. However, the updated immunization administration rates cannot exceed the maximum regional charge, currently $15.22, as determined by CMS. This rate is used where applicable. The updated rates can be found on the Immunization Fee Schedules located on the Medicaid website, www.lamedicaid.com, following the Fee Schedules link. Affected claims paid at the previous rate will be systematically adjusted in the near future and no action will be required by providers. Please monitor your RA's for the specific date(s) the adjustments will take place.


A slide presentation with detailed information on Louisiana Medicaid's CommunityCARE Immunization Pay-for-Performance Initiative has been placed on the LA Medicaid website (www.lamedicaid.com) following the link for Pay-for-Performance in the directory on the home page. Providers that administer immunizations to Medicaid enrolled children are encouraged to review this material online.


LA Medicaid has placed three vaccine CPT procedure codes in non-payable status for Medicaid recipients. These vaccines are no longer available from VFC as they are no longer acceptable for use in the United States. The two components affected are DTP, which has been replaced with DTaP, and OPV, as oral polio vaccine is no longer used in the US. The non-payable codes are: 90701, 90712, and 90720. Please review the online Immunization Fee Schedule at www.lamedicaid.com for acceptable vaccine codes and ensure that you are using the correct procedure code for the vaccine administered.


We continue to receive questions from providers concerning the 2007 policy clarification related to billing ONLY ONE revenue code 450 for out-patient emergency room visits and the recent RA message related to this subject indicating that denial edits are now in place to prevent billing multiple 450-459 revenue codes in these circumstances. We understand that Medicare and other payers allow billing multiple 450-459 codes in certain circumstances, however, this is NOT LA Medicaid policy.

The appropriate level of ER visit code should be billed on your outpatient claim form, and the services performed MAY NOT be billed separately under other 450-459 codes or any other revenue codes. The appropriate HCPC designating the applicable level of ER visit (99281-99285) is the only allowed HCPC.

Claims should include all other appropriate revenue codes (i.e. pharmacy, lab, x-rays and supplies) which were utilized in the patient's treatment, using the appropriate revenue code and procedure code/HCPC if applicable.

Hospitals should establish a charge/fee for EACH level of emergency room visit (99281-99285). That charge/fee is all-inclusive for whatever services are being performed in the emergency room/department (i.e. use of room, injections, infusions, suturing, casting, etc.) Any non-ambulatory surgical (HR490) services performed in the ER such as the application of splints, injections, suturing, etc. are built into the reimbursement paid to the hospital under one of the 5 ER visit codes depending on the level of complexity of the ER visit.


Louisiana Medicaid is in the process of completing the programming for the 2009 HCPCS updates. This includes both new and deleted codes for 2009. Every attempt is being made to have the new codes/updates on file by mid January 2009. Please note that all appropriate editing and coverage determinations for the new codes may not be final at that time and adjustments to claims processed may be necessary. Providers should monitor future RA messages.


The Louisiana Legislature has funded additional New Opportunity Waiver slots through the NOW Trust Fund. Most New Opportunity Waiver slots filled on or after November 3, 2008 are part of the NOW Trust Fund. A system for processing claims for recipients of this group is currently in development. Claims for any Medicaid services provided for NOW Trust Fund recipients of waiver slots will not be accepted until after January 1, 2009. At that time, all claims for these recipients will be held as "pending" with a tentative payment begin date of February 1, 2009. However, providers will be notified as soon as programming is completed, and payment of the pending claims will move forward for final processing at that time.