Provider Notices 2012

Emails relevant to rules, Medicaid provider billing guides, and policies

Notice number Subject Issue date Effective date
12-118 Hospitals: Revised Inpatient Hospital Services Medicaid Provider Guide (MPG). 12/27/12 01/01/13
12-117 Outpatient Hospital: Revised Medicaid Provider Guide and OPPS fee schedule 12/22/12 01/01/13
12-116 Blood Banks: Added procedure code 86711 John Cunningham antibody and procedure code J7178, Human figrinogen conc inj. 12/26/12 01/01/13
12-115 Prescription Drug Program: Require authorization for all Leukotriene modifiers 12/14/12 05/01/12
12-114 Chiropractic Services: The Agency is notifying providers that clients 19 through 20 years of age covered under the Medical Care Services or the Alcohol, Drug Addiction and Support Act programs are not eligible for chiropractic services. 12/21/12 01/01/13
12-113 Provider Notice number is void    
12-112 Dental: Revisions reflect recent coverage changes. 12/24/12 01/01/13
12-111 Dental: Revised Dental-Related Service Medicaid Provider Guide. The guide's revisions reflect recent coverage changes. 12/26/12 01/01/13
12-110 Ambulatory Surgery Centers: Fee Schedule updates 12/14/12 01/01/13
12-109 FQHC's: Correction by adding code S9436 as an exception to the policy that S codes are excluded from encounter payments 12/17/12 01/01/13
12-108 DME, MSE and P&O: Update coverage and prior authorization for selected procedure codes 12/27/12 01/01/13
12-107 Vision Hardware: Added criteria for replacement frames, procedure codes 92071 and 92072 and criteria when client does not pick up eyeglasses 12/19/12 01/01/13
12-106 Physician-Related Services: Update coverage and prior authorization for selected procedure codes. 12/28/12 01/01/13
12-105 Family Planning: Revised to replace code J1055 with J1050 for prescription birth control methods, and add several hysteroscopic sterilization codes to the coverage table 12/19/12 01/01/13
12-104 Home Health Services: Added billing clarifications, including a change for clients 19 through 20 years of age in MCS/ADATSA. Also, added requirement for providers to report to Medicare’s OASIS 12/18/12 01/01/13
12-103 Home Infusion/Parenteral Nutrition: Effective 1/1/2013, ending EPA number 870000023 for procedure codes A9276, A9277, and A9278 for Continuous Glucose Monitoring (CGM) 12/07/12 01/01/13
12-102 EPSDT: Added procedure code 90672 to list of No Cost Immunizations from the Department of Health, replaced code D1203 with D1208 for topical application of fluoride, and clarified limits. 12/19/12 01/01/13
12-101 Respiratory Care: Updating the coverage table codes and symbols for January 2013 12/18/12 01/01/13
12-100 Hearing Hardware: Updated fee schedule with new abbreviations to replace the “#” indicator 12/14/12 01/01/13
12-98 Kidney Center Services: Replacing procedure code Q2047 with procedure code J0890 and updating fee schedule with new maximum allowable fees 12/19/12 01/01/13
12-97 Provider Notice number is void    
12-96 Mental Health Services: Revised the Mental Health Services for Children, Psychiatric and Psychologist Services Medicaid Provider Guide with multiple procedure code changes, prior authorization and coverage changes, and revised the fee schedule. 12/21/12 01/01/13
12-95 Outpatient Rehabilitation (PT, ST, OT): Clients 19 through 20 years of age in MCS/ADATSA are not eligible for unlimited outpatient rehabilitation. These clients are eligible for the short term benefit. 12/17/12 01/01/13
12-94 Prescription Drug: Maximum Allowable Cost Update 11/29/12 01/01/13
12-93 Physicians-Related Services: Fee Schedule Changes J9042 12/03/12 01/01/13
12-92 Prescription Drug Program: Multiple updates including Buprenorphine for pregnant women, mental health polypharmacy, and billing for vaccine administration 12/19/12 01/01/13
12-91 Prescription Drug: Maximum Allowable Cost Update 10/30/12 12/01/12
12-90 Maternity Support Services and Infant Case Management MPG: Revised to add TF and TG modifiers 10/29/12 11/01/12
12-89 Prescription Drug: Revised Washington Preferred Drug List 10/19/12 12/01/12
12-88 Physician-Related Services: Hemophilia-and von Willebrand-related products must be dispensed by a qualified hemophilia Center of Excellence 10/19/12 11/01/12
12-87 Prescription Drug: Hemophilia-and von Willebrand-related products must be dispensed by a qualified hemophilia Center of Excellence. 10/19/12 11/01/12
12-86 Provider Notice number is void    
12-85 Dental: Clarify the expedited prior authorization (EPA) process and update criteria information on the EPA procedure code list 10/10/12 Retro to 10/01/12
12-26 Pharmacy: Extension of Pharmacist enrollment requirement message for hospitals and pharmacies 6/19/12 6/19/12