DOH Medicaid Update July 1999 Vol.14, No.7
Office of Medicaid Management
DOH Medicaid Update
July 1999 Vol.14, No.7
State of New York
George E. Pataki, Governor
Department of Health
Antonia C. Novello, M.D., M.P.H., Dr. P.H.
is a monthly publication of the
New York State Department of Health,
Office of Medicaid Management,
14th Floor, Room 1466,
Corning Tower, Albany,
New York 12237
Table of Contents
Attention: Providers of Inpatient Substance Abuse Services
Medicaid Recipients Cannot Be Billed
Y2K and Medicaid Claims
Attention Pharmacists - Policy on Faxed, Electronic and Transferred Prescriptions
Medicaid Coverage Criteria for Rental of Hospital Grade Breast Pumps
Attention Pharmacy Providers - Directions for Dispensing Validation Required for Viagra
Viagra Claim Submission Instructions for DVS/DUR
Attention Nursing Home and Pharmacy Providers
Drugs Not Included in Nursing Home Rates (Rev. 06/28/1999)
Parenteral Formulea and Parenteral Supplies
Lawsuit Billing Information
Medicare Crossover Lawsuit
ATTENTION: PROVIDERS OF INPATIENT SUBSTANCE ABUSE SERVICES
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This is to advise you of a change in the date that inpatient detoxification services will be added to the managed care benefit package for Supplemental Security Income ( SSI) recipients.
For the period April 1, 1998, the effective date of the SSI health only benefit package, through September 30, 1999, detoxification services provided on an inpatient basis in Article 28 hospitals to SSI Medicaid managed care enrollees should be billed directly to the Medicaid Management Information System ( MMIS) by the Medicaid provider. The system has been modified to allow Medicaid fee-for-service payments for DRG codes 743 through and including 751. Managed care plans that have paid providers for these services may seek recovery from the provider of service and instruct them to bill Medicaid fee-for-service.
Effective October 1, 1999, all inpatient detoxification services provided by Article 28 hospitals to SSI Medicaid managed care enrollees will be included in the SSI benefit package provided by managed care plans. For services on or after October 1, 1999, providers will bill the patient's managed care plan. All other detoxification services will continue to be considered alcohol and substance abuse services and are not included in the SSI health-only benefit package provided by the managed care plan.
If there are any questions, please contact Barbara Frankel at (518) 473-7467.
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Effective August 1, 1999, the New York State Medicaid Program will accommodate the expanded scope of practice of optometrists as set forth in Section 7101 of the State Education Law. The additional billable procedures for optometrists are:
|92060||Sensorimotor examination with multiple measurements of ocular deviation (e.g., restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)||*By Report|
|92082||Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold Automatic diagnostic test, (Octopus program 33)||$8.00|
|92083||Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees, or quantitative automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2 or 30/60-2)||$8.00|
|92226||Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), (one or both eyes), with interpretation and report; subsequent to 92225||$15.00|
|92250||Fundus photography with interpretation and report||$16.00|
*By Report: When billing "By Report", a statement which indicates the nature, extent, and need for the service, the time, the skill and equipment required, including appropriate documentation (e.g., itemized invoice) indicating the total cost of any items or materials, and any other factor which may be pertinent, must be submitted with the claim.
Additional optometric procedure codes are being considered upon clarification of the scope of optometric practice by the State Education Department.
On August 1, 1998, the New York State Medicaid Program added office visit codes to the optometric fee schedule to reflect optometrists' certification to diagnose and treat diseases of the eye and to prescribe Phase I and Phase II pharmaceutical agents. Optometrists must be appropriately certified by State Education Department (SED) to bill Medicaid for office visits for the diagnosis and treatment of diseases of the eye and to prescribe Phase I pharmaceutical agents authorized under the Law. When SED begins to certify optometrists for Phase II, additional procedures may be added. The new billable procedure codes for Phase I are:
|99201||Office visit for evaluation and management of new patient, which requires three key components: a problem focused history, a problem focused examination, and straight forward medical decision making.||$7.20|
|99202||Office visit for evaluation and management of new patient, which requires three key components: an expanded problem focused history, an expanded problem focused exam, and straight forward medical decision making.||$7.20|
|99211||Office visit for evaluation and management of an established patient who presents for follow-up and/or periodic re-evaluation of problems or for the evaluation and management of new problem(s) in established patients.||$7.20|
|99212||Office visit for the evaluation and management of an established patient which requires a problem focused history, a problem focused examination, and/or straight forward medical decision making.||$7.20|
When billing for the above procedures diagnosis coding will be required on the claim form in Field 24F, Diagnosis Code. Using the International Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9-CM) coding system, enter the appropriate code which describes the main condition or symptom of the recipient for which the procedure was performed. The diagnosis code digits should be entered in the correct spaces in relation to the decimal point. Diagnosis codes with subcategories must be entered with the subcategories indicated after the decimal point. A 3-digit diagnosis code (no entry following the decimal point) will only be accepted when the diagnosis code has no subcategories. The following is an example of an ICD-9-CM diagnosis code properly entered in Field 24F:
Questions concerning this matter should be directed to 518-474-1713.
MEDICAID RECIPIENTS CANNOT BE BILLED
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This is a reminder to all hospitals, free-standing clinics and individual practitioners about billing requirements of the Medicaid Program related to requesting compensation from Medicaid recipients. When a provider accepts a Medicaid recipient as a patient and agrees to bill Medicaid for the services provided, the provider is prohibited from requesting any monetary compensation from that individual, or his/her responsible relative, except for Medicaid co-payments, if such co-payments are applicable. If, for example, the provider sees a patient, advises him/her that the Medicaid card is valid and eligibility exists for the date of service and then treats the individual, the provider may not change his/her mind and bill the patient for that service or any part of that service. A provider may charge a Medicaid recipient for services only when both parties have agreed prior to the rendering of the service that the recipient is being seen as a private pay patient; this must be a mutual and voluntary decision. It is suggested that the provider maintain the patient's signed consent to be treated as private pay in the patient record.
Further, a Medicaid recipient must not be referred to a collection agency for unpaid medical bills when the provider has accepted the individual as a Medicaid recipient. Similarly, the provider must not bill the individual in cases where he/she was treated as a Medicaid recipient, but the provider failed to submit a claim to Computer Sciences Corporation (CSC) for payment within the required timeframes or submitted a claim which was subsequently denied for reasons other than recipient ineligibility. The policies in this article do not apply to Medicaid co-payments. Providers may use any legal means to collect applicable unpaid Medicaid co-payments.
If a problem arises as a result of submitting a claim, the provider should first contact CSC. If CSC is not able to resolve the issue because some action must be taken by the recipient's local Department of Social Services, such as providing the claiming address of a health insurance company or terminating a closed health insurance policy, the local Department of Social Services should be contacted for resolution.
It is important to emphasize a hospital's responsibilities in the treatment of a Medicaid patient. A hospital that accepts a Medicaid patient for treatment accepts the responsibility of making sure that the patient receives all medically necessary care and services. Other than for legally established co-payments, a Medicaid recipient should never be required to have any out-of-pocket expenses for medically necessary inpatient services or medically necessary services provided in a hospital based emergency room (ER), unless arrangements for private payment have been mutually agreed upon prior to the service(s) being rendered. Because of the acute nature of an ER visit, it is unlikely that prior mutual agreement between the Medicaid patient and provider can occur in an ER.
NOTE: The above noted policy applies regardless of whether the individual practitioner treating the individual in the facility is enrolled in the Medicaid Program.
Questions related to this policy should be directed to Barbara Pukis at (518) 486-5870.
Y2K AND MEDICAID CLAIMS
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The Department has received numerous inquiries from providers and provider groups related to Y2K procedures and readiness to process and pay Medicaid claims after December 31, 1999. The following will summarize the steps which have and will be taken to ensure that the Medicaid Management Information System (MMIS) claims processing system will suffer no interruption when the century changes.
Fiscal Agent Readiness
The claims processing system used by Computer Sciences Corporation (CSC) to receive, process, and pay Medicaid claims has been modified where necessary, fully tested, and promoted as fully Y2K compliant since July of 1998.
Provider Claiming Requirements
The basic philosophy of the CSC Y2K compliance effort has been to ensure that providers will be impacted as little as possible in their claiming procedures. As a result, no changes have been made to any claiming forms or magnetic/electronic formats. This means that providers will not need to make changes of any kind to their own claiming procedures. All date fields will continue to be filled in the same manner as they currently are. Clinic and inpatient hospital providers will continue to have the option of billing either via Version 4 or Version 5. NCPDP version 3.2 will continue to be used for pharmacy claims capture via EMEVS.
There will be no changes to claiming formats, or to the date fields on formats. Providers will continue to enter date-related data using the same conventions as are currently in use. There is, therefore, no need for providers to test their ability to continue to complete claim forms as they already do.
The fiscal agent's claims testing process uses production files and test claims in the production environment. It is not possible to test claims with future dates in such an environment, because all dates in the production files and operating environment are, of necessity, related to the current calendar. Providers will, therefore, not be able to submit test claims with future dates.
Fiscal Agent "End to End" Testing
The Department has instructed the MMIS fiscal agent to replicate the entire production system off-site so that an entire production cycle can be run in a post 12/31/99 environment. This event will take place in Philadelphia at the end of July, 1999. Claims representing every possible combination of provider type and submission media (paper, magnetic media, electronic submission, PACES, EMEVS, claim capture) will be input. Claims input will be carefully controlled so that results can be compared to previously successfully processed claims. Due to the cost and effort required this will be a one-time event. The results of this testing will be reported to all providers in a subsequent issue of the Medicaid Update.
Questions concerning this article should be directed to Al Fike at 518-473-8681.
POLICY ON FAXED, ELECTRONIC AND TRANSFERRED PRESCRIPTIONS
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Recent amendments to the Rules of the Board of Regents and Regulations of the Commissioner of Education allow pharmacists to fill prescriptions received by fax or e-mail. However, the New York State Medicaid program, for payment purposes, will recognize a fax prescription only under the circumstances when a phone order is currently allowed. Under current regulations (Title 18, Section 505.3 (b)) and the Medicaid Management Information System (MMIS) Pharmacy Provider Manual guidelines, phone orders are not acceptable for non-prescription drugs and drugs which require the official triplicate prescription form. Prescriptions that include refills, or are written as "DAW", "Brand Medically Necessary" must be followed by an original written prescription within five (5) business days. All other requirements for phone orders must be met, including in particular, the requirement that the pharmacist make a good faith effort to verify the practitioner's identity, if the practitioner is unknown to the pharmacist.
E-mail prescriptions and transferred original prescription information will not be recognized by the Medicaid program for payment purposes at this time. Additional guidelines will be distributed in the future on these issues.
MEDICAID COVERAGE CRITERIA FOR RENTAL OF HOSPITAL GRADE BREAST PUMPS
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Rental of hospital grade breast pumps for use in the home requires prior approval. Coverage is limited to the following indications:
- Prematurity (including multiple gestation)
- Neurologic disorders
- Genetic abnormalities (e.g., Down's Syndrome)
- Anatomic and mechanical malformations (e.g., cleft lip and palate)
- Congenital malformations requiring surgery (e.g., respiratory, cardiac, gastrointestinal, central nervous system)
- Prolonged infant hospitalization
- Other conditions that prevent normal breastfeeding (e.g., respiratory compromise)
Initial rental approval will be for sixty (60) days. For extreme prematurity (infants less than 28 weeks gestation), the initial rental period may be up to 90 days. Extensions of the approved period of rental will be considered on an individual determination of continuing medical need.
Questions should be directed to Deborah Henderson, Prior Approval Unit, at 1-800-342-3005.
ATTENTION PHARMACY PROVIDERS
DIRECTIONS FOR DISPENSING VALIDATION REQUIRED FOR VIAGRA
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The following information was sent to all enrolled pharmacies on June 14, 1999, regarding Viagra dispensing. Approval through the Dispensing Validation System (DVS) is required for Viagra prescriptions effective July 1, 1999. Please read the following information carefully to assure proper claims processing.
Prescriptions for Viagra will be subject to both DVS and Drug Utilization Review (DUR) system editing.
- Approval must be obtained through DVS by using the National Drug Code (NDC) number for the strength of the drug prescribed. The claim will go through all DVS editing.
- Upon receiving the DVS approval number, the pharmacist should record the number. This number is necessary for all adjustments and claim resubmissions.
- The DVS claim date must match the date of dispensing.
- Early refills, vacation supplies, and replacements for lost prescriptions are prohibited. A DVS denial will be received for these circumstances.
- Claims with a DVS approval will also be subject to all DUR edits to assure the patient is not currently receiving any contraindicated drugs.
- Only one strength of Viagra may be dispensed during a month. If more than one strength has been dispensed, the pharmacy provider will receive a Therapeutic Duplication (TD) indicator. Do not override - you will not be paid. Payment will be denied in this instance; this serves as a forewarning of this action.
Viagra Claim Submission Instructions for DVS/DUR:
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- The Viagra transaction can be submitted through both the DUR NCPDP 3.2 variable format and RTDS "3A" fixed formats.
- Only one DVS transaction can be submitted at a time. Use NCPDP field 103 (Transaction Code), Value 01 only. If other DUR NDC codes are submitted in the same transaction (Values 02-04), the first claim must be the Viagra DVS claim.
- The pharmacy's category of service must be entered in the last four positions (29-32) of NCPDP field 201 (Pharmacy Number). Valid categories of service are 0441 (Freestanding Pharmacy), 0161 (Clinic Pharmacy), and 0288 (Hospital Pharmacy).
- NCPDP field 406 (Compound Code) must contain a Value of 1.
- The Viagra NDC must be entered in NCPDP field 407 (NDC Number). The Alternate Product Type and Code Fields (NCPDP Fields 436 and 437) must not be sent in the Viagra claim transaction. If your software automatically sends these fields, they must be blank. Any other values transmitted in these fields (including zeros) will cause your claim to deny.
- The Date of Service must be the current date for a DVS transaction.
- Each Viagra refill requires a new DVS number. For example, a prescription written for an original and two refills would require THREE UNIQUE DVS NUMBERS. Pharmacies should make sure that the previously issued DVS number for that script is cleared from their software prior to transmitting each script's refill. Depending on your software, failure to clear the number transmits the previous DVS number on the claim and prevents a new DVS number from being issued, causing the claim to be denied by the fiscal agent's DVS approval processing edits.
- If approved, a DVS approval number will be returned in field 526. If rejected, a reason code will be returned.
- DVS reason codes are returned in the response in NCPDP field 504 (Message), positions 89-91 (variable 3.2 format) and positions 100-102 (fixed RTDS 3A format). A list of these reason codes can be found in Table 9, page 64 of the DUR Provider Manual.
- The eight-digit DVS number is returned in NCPDP field 526 (Additional Message) positions 68-75 (variable 3.2 format) and positions 345-352 (fixed RTDS 3A format).
- FOR FUTURE REFERENCE, ALWAYS RECORD THE DVS NUMBER WHEN RETURNED.
- DVS instructions can be found in your DUR Provider Manual on pages 10 and 11.
NOTE: Viagra prescriptions may not be filled via a telephone call (or faxed prescription). The original prescription must be in hand at the time it is filled by a pharmacist.
For further information on the policy regarding Viagra, please call the Pharmacy Policy Unit at (518) 486-3209. Should you have questions regarding the actual on-line transmission of a Viagra claim, please call Deluxe Data at 1-800-343-9000.
ATTENTION NURSING HOME AND PHARMACY PROVIDERS
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The following listing includes all drugs which have been determined not to be included within the drug cost components of Article 28 Nursing Facility Rates. Drugs indicated in bold print are the most recent additions to this list. Claims for the drugs indicated on this list may be billed directly to Medicaid by a Medicaid Management Information System (MMIS) enrolled pharmacy when the recipient is a patient of a Nursing Facility. Claims for the drugs indicated in bold print that are submitted more than 90 days from the dispensing date must be submitted with a copy of this article. Computer Sciences Corporation must receive these claims no later than 12:00 P.M. (noon) on September 30, 1999.
DRUGS NOT INCLUDED IN NURSING HOME RATES (REV. 06/28/1999)Return to Table of Contents
|12/30/1998||Abacavir sulf.||Ziagen||tab 300 mg||00173-0661-01|
|12/30/1998||Abacavir sulf.||Ziagen||sol 20 mg/ml||00173-0664-00|
|04/26/1999||Amprenavir||Agenerase||cap 150 mg||00173-0672-00|
|04/26/1999||Amprenavir||Agenerase||cap 50 mg||00173-0679-00|
|04/15/1992||AZT||Retrovir||cap 100 mg||00081-0108-55|
|04/15/1992||AZT||Retrovir||cap 100 mg||00081-0108-56|
|04/15/1992||AZT||Retrovir||Syrup 240 ml||00081-0113-18|
|08/12/1996||AZT||Retrovir||inj 10 mg/ml||00173-0107-93|
|07/09/1996||AZT||Retrovir||cap 100 mg||00173-0108-55|
|08/12/1996||AZT||Retrovir||Syrup 240 ml||00173-0113-18|
|08/12/1996||AZT||Retrovir||inj 10 mg/ml||00173-0107-93|
|10/14/1996||AZT||Retrovir||cap 300 mg||00173-0501-00|
|07/01/1997||AZT||Retrovir||cap 100 mg||54569-1772-03|
|04/15/1992||Clozapine||Clozaril||tab 25 mg||00078-0126-05|
|04/15/1992||Clozapine||Clozaril||tab 100 mg||00078-0127-05|
|12/01/1997||Clozapine||tab 25 mg||00172-4359-60|
|12/01/1997||Clozapine||tab 25 mg||00172-4359-70|
|12/01/1997||Clozapine||tab 100 mg||00172-4360-60|
|12/01/1997||Clozapine||tab 100 mg||00172-4360-70|
|02/01/1996||Cyclosporine||Neoral||cap 25 mg||00078-0246-15|
|02/01/1996||Cyclosporine||Neoral||sol 100 mg/ml||00078-0274-22|
|08/01/1995||Cyclosporine||Sandimmune||inj 50 mg/ml||00078-0109-01|
|08/01/1995||Cyclosporine||ndimmune||sol 100 mg/ml||00078-0110-22|
|08/01/1995||Cyclosporine||Sandimmune||cap 25 mg||00078-0240-15|
|08/01/1995||Cyclosporine||Sandimmune||cap 100 mg||00078-0241-15|
|08/01/1995||Cyclosporine||Sandimmune||cap 50 mg||00078-0242-15|
|07/27/1992||DDC||HIVID||tab 0.375 mg||00004-0220-01|
|07/27/1992||DDC||HIVID||tab 0.75 mg||00004-0221-01|
|04/11/1997||Delavirdine||Rescriptor||tab 100 mg||00009-3761-03|
|10/01/1996||Didanosine||Videx||pow 100 mg||00087-6614-43|
|10/01/1996||Didanosine||Videx||pow 167 mg||00087-6615-43|
|10/01/1996||Didanosine||Videx||pow 250 mg||00087-6616-43|
|10/01/1996||Didanosine||Videx||chw 50 mg||00087-6624-43|
|10/01/1996||Didanosine||Videx||chw 150 mg||00087-6626-43|
|10/01/1996||Didanosine||Videx||chw 100 mg||00087-6627-43|
|10/01/1996||Didanosine||Videx||chw 25 mg||00087-6628-43|
|10/01/1996||Didanosine||Videx||pow 2 gm||00087-6632-41|
|10/01/1996||Didanosine||Videx||pow 4 gm||00087-6633-41|
|10/01/1996||Didanosine||Videx Buffer||chw 25 mg||00087-6650-01|
|10/01/1996||Didanosine||Videx Buffer||chw 50 mg||00087-6651-01|
|10/01/1996||Didanosine||Videx Buffer||chw 100 mg||00087-6652-01|
|10/01/1996||Didanosine||Videx Buffer||chw 150 mg||00087-6653-01|
|09/18/1998||Efavirenz||Sustiva||cap 50 mg||00056-0470-30|
|09/18/1998||Efavirenz||Sustiva||cap 100 mg||00056-0473-30|
|09/18/1998||Efavirenz||Sustiva||cap 200 mg||00056-0474-92|
|06/07/1989||Epoetin, alfa||Epogen||inj 2,000 I.U./ml||55513-0126-01|
|01/01/1994||Epoetin, alfa||Epogen||inj 2,000 I.U./ml||55513-0126-10|
|06/02/1989||Epoetin, alfa||Epogen||inj 10,000 I.U./ml||55513-0144-01|
|01/01/1994||Epoetin, alfa||Epogen||10,000 I.U./vial||55513-0144-10|
|06/02/1989||Epoetin, alfa||Epogen||inj 4,000 I.U./ml||55513-0148-01|
|01/01/1994||Epoetin, alfa||Epogen||4,000 I.U./vial||55513-0148-10|
|04/26/1990||Epoetin, alfa||Epogen||inj 3,000 I.U./ml||55513-0267-01|
|01/01/1994||Epoetin, alfa||Epogen||3,000 l.U./vial||55513-0267-10|
|01/03/1995||Epoetin, alfa||Epogen||10,000 I.U./vial||55513-0283-10|
|03/10/1997||Epoetin, alfa||Epogen||inj 20,000 I.U./ml||55513-0478-01|
|03/10/1997||Epoetin, alfa||Epogen||inj 20,000 I.U./ml||55513-0478-10|
|02/08/1999||Epoetin, alfa||Epogen||inj 40,000 I.U./ml||55513-0823-01|
|02/08/1999||Epoetin, alfa||Epogen||inj 40,000 I.U./ml||55513-0823-10|
|01/01/1994||Epoetin, alfa||Procrit||3,000 I.U./vial||00062-0303-02|
|01/01/1994||Epoetin, alfa||Procrit||4,000 I.U. vial||00062-0304-02|
|01/01/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||00062-0310-02|
|01/01/1994||Epoetin, alfa||Procrit||4,000 I.U./vial||00062-7400-03|
|01/01/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||00062-7401-03|
|01/01/1994||Epoetin, alfa||Procrit||2,000 I.U./vial||00062-7402-01|
|01/01/1994||Epoetin, alfa||Procrit||3,000 I.U./vial||00062-7405-01|
|01/01/1994||Epoetin, alfa||Procrit||2,000 I.U. vial||59676-0302-01|
|01/01/1994||Epoetin, alfa||Procrit||2,000 I.U./vial||59676-0302-02|
|01/01/1994||Epoetin, alfa||Procrit||3,000 I.U./vial||59676-0303-01|
|01/01/1994||Epoetin, alfa||Procrit||3,000 I.U./vial||59676-0303-02|
|01/01/1994||Epoetin, alfa||Procrit||4,000 I.U. vial||59676-0304-01|
|01/01/1994||Epoetin, alfa||Procrit||4,000 I.U. vial||59676-0304-02|
|01/01/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||59676-0310-01|
|01/01/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||59676-0310-02|
|10/24/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||59676-0312-00|
|10/24/1994||Epoetin, alfa||Procrit||10,000 I.U./vial||59676-0312-01|
|03/03/1997||Epoetin, alfa||Procrit||20,000 I.U./ml||59676-0320-01|
|01/25/1999||Epoetin, alfa||Procrit||inj 40,000 I.U./ml||59676-0340-01|
|07/27/1992||Factor IX||ALPHANINE||100-650 I.U./vial||49669-3900-01|
|07/27/1992||Factor IX||ALPHANINE||651-2,000 I.U. vial||49669-3900-02|
|07/27/1992||Factor IX||KONYNE-80||500 I.U./vial||00161-0626-20|
|07/27/1992||Factor IX||KONYNE-80||1,000 I.U./vial||00161-0626-50|
|07/27/1992||Factor IX||KONYNE-HT||500 I.U./vial||00161-0625-20|
|07/27/1992||Factor IX||KONYNE-HT||1,000 I.U./vial||00161-0625-50|
|07/27/1992||Factor IX||PROFILNINE||100-650 I.U./vial||49669-3700-01|
|07/27/1992||Factor IX||PROFILNINE||651-1,200 I.U./vial||49669-3700-02|
|07/27/1992||Factor IX||PROPLEX-T||700-3,900 I.U./vial||00944-0581-01|
|07/27/1992||Factor VIII||AHF-N||200-1,500 I.U./vial||52769-0460-01|
|07/27/1992||Factor VIII||HEMOFIL-M||200-1,500 I.U./vial||00944-2935-01|
|07/27/1992||Factor VIII||HUMATE-P||250 I.U./vial||00053-7605-01|
|07/27/1992||Factor VIII||HUMATE-P||500 I.U./vial||00053-7605-02|
|07/27/1992||Factor VIII||HUMATE-P||1,000 I.U./vial||00053-7605-04|
|07/27/1992||Factor VIII||HYATE-C||400-700 I.U./vial||55688-0106-02|
|07/27/1992||Factor VIII||KOATE-HP||250 I.U./vial||00161-0664-20|
|07/27/1992||Factor VIII||KOATE-HP||500 I.U./vial||00161-0664-30|
|07/27/1992||Factor VIII||KOATE-HP||1,000 I.U. vial||00161-0664-50|
|07/27/1992||Factor VIII||KOATE-HP||1,500 I.U./vial||00161-0664-60|
|07/27/1992||Factor VIII||KOATE-HS||250 I.U./vial||00161-0660-20|
|07/27/1992||Factor VIII||KOATE-HS||500 I.U. vial||00161-0660-30|
|07/27/1992||Factor VIII||KOATE-HS||1,000 I.U./vial||00161-0660-50|
|07/27/1992||Factor VIII||MONOCLATE-P||250 I.U./vial||00053-7656-01|
|07/27/1992||Factor VIII||MONOCLATE-P||500 I.U./vial||00053-7656-02|
|07/27/1992||Factor VIII||MONOCLATE-P||1,000 I.U./vial||00053-7656-04|
|07/27/1992||Factor VIII||PROFILATE-HP||100-650 I.U./vial||49669-4200-01|
|07/27/1992||Factor VIII||PROFILATE-HP||651-2,000 I.U./vial||49669-4200-02|
|07/27/1992||Factor VIII||PROFILATE-OSD||100-650 I.U./vial||49669-4300-01|
|07/27/1992||Factor VIII||PROFILATE-OSD||651-2,000 I.U./vial||49669-4300-02|
|07/27/1992||Factor VIII||PROFILATE-SD||100-650 I.U./vial||49669-4100-01|
|07/27/1992||Factor VIII||PROFILATE-SD||651-2,000 I.U./vial||49669-4100-02|
|10/08/1993||Foscarnet Sodium||Foscavir||inj 24 mg/ml||00186-1905-01|
|10/08/1993||Foscarnet Sodium||Foscavir||inj 24 mg/ml||00186-1906-01|
|12/05/1995||Ganciclovir||Cytovene||cap 250 mg||00004-0269-48|
|02/09/1998||Ganciclovir||Cytovene||cap 500 mg||00004-0278-48|
|02/26/1996||Ganciclovir||Cytovene||inj 500 mg||00004-6940-03|
|04/15/1992||Ganciclovir||Cytovene||inj 500 mg||00033-2903-48|
|01/20/1995||Ganciclovir||Cytovene||cap 250 mg||00033-2913-50|
|03/01/1999||Indinavir||Crixivan||cap 333 mg||00006-0574-65|
|10/01/1996||Indinavir sulf.||Crixivan||cap 200 mg||00006-0571-42|
|10/01/1996||Indinavir sulf.||Crixivan||cap 200 mg||00006-0571-43|
|06/02/1997||Indinavir sulf.||Crixivan||cap 400 mg||00006-0573-54|
|10/01/1996||Indinavir sulf.||Crixivan||cap 400 mg||00006-0573-62|
|07/27/1992||Inhibitor||AUTOPLEX T||inj vial||00944-0650-01|
|01/08/1996||Inhibitor||DDAVP||tab 0.1 mg||00075-0016-00|
|01/08/1996||Inhibitor||DDAVP||tab 0.2 mg||00075-0026-00|
|07/27/1992||Inhibitor||DDAVP||0.1 mg/ml nasal spray||00075-2450-02|
|06/23/1997||Inhibitor||DDAVP||sol 0.01 %||00075-2452-01|
|07/27/1992||Inhibitor||FEIBAVH||400 I.U.-800 I.U.||54129-0222-04|
|09/01/1993||Interferon beta||BETASERON||0.3 mg/vial||50419-0521-01|
|09/30/1994||Interferon beta||BETASERON||0.3 mg/vial||50419-0521-03|
|01/01/1994||Interferon beta||BETASERON||0.3 mg/vial||50419-0521-05|
|09/30/1994||Interferon beta||BETASERON||0.3 mg/vial||50419-0521-15|
|10/01/1996||Lamivudine||Epivir||tab 150 mg||00173-0470-01|
|10/01/1996||Lamivudine||Epivir||sol 10 mg/ml||00173-0471-00|
|07/01/1997||Lamivudine||Epivir||tab 150 mg||54569-4221-01|
|12/21/1998||Lamivudine||Epivir HBV||tab 100 mg||00173-0662-00|
|12/21/1998||Lamivudine||Epivir HBV||sol 5 mg/ml||00173-0663-00|
|03/14/1997||Nelfinavir||Viracept||tab 250 mg||63010-0010-27|
|03/14/1997||Nelfinavir||Viracept||pow 50 mg/gm||63010-0011-90|
|10/05/1998||Nevirapine||Viramune||Susp 50 mg/5 ml||00054-3905-58|
|10/05/1998||Nevirapine||Viramune||tab 200 mg||00054-4647-21|
|10/01/1996||Nevirapine||Viramune||tab 200 mg||00054-4647-25|
|09/01/1997||Olanzapine||Zyprexa||tab 2.5 mg||00002-4112-60|
|09/01/1997||Olanzapine||Zyprexa||tab 5 mg||00002-4115-60|
|09/01/1997||Olanzapine||Zyprexa||tab 7.5 mg||00002-4116-60|
|04/15/1992||Pentamidine||Pentam 300||300 mg||00469-1130-91|
|04/15/1992||Pentamidine||Pentam 300||300 mg||57317-0211-03|
|04/01/1997||Risperidone||Risperdal||tab 1 mg||50458-0300-06|
|04/01/1997||Risperidone||Risperdal||tab 1 mg||50458-0300-50|
|04/01/1997||Risperidone||Risperdal||sol 1 mg/ml||50458-0305-10|
|04/01/1997||Risperidone||Risperdal||tab 2 mg||50458-0320-06|
|04/01/1997||Risperidone||Risperdal||tab 2 mg||50458-0320-50|
|04/01/1997||Risperidone||Risperdal||tab 3 mg||50458-0330-06|
|04/01/1997||Risperidone||Risperdal||tab 3 mg||50458-0330-50|
|04/01/1997||Risperidone||Risperdal||tab 4 mg||50458-0350-06|
|10/01/1996||Ritonavir||Norvir||sol 80 mg/ml||00074-1940-63|
|10/01/1996||Ritonavir||Norvir||cap 100 mg||00074-9492-02|
|10/01/1996||Ritonavir||Norvir||cap 100 mg||00074-9492-54|
|11/17/1997||Saquinavir Mes.||Fortovase||cap 200 mg||00004-0246-48|
|10/01/1996||Saquinavir Mes.||Invirase||cap 200 mg||00004-0245-15|
|10/01/1996||Stavudine||Zerit||cap 15 mg||00003-1964-01|
|10/01/1996||Stavudine||Zerit||cap 20 mg||00003-1965-01|
|10/01/1996||Stavudine||Zerit||cap 30 mg||00003-1966-01|
|10/01/1996||Stavudine||Zerit||cap 40 mg||00003-1967-01|
|01/27/1997||Stavudine||Zerit||sol 1 mg/ml||00003-1968-01|
|03/15/1999||Tacrolimus||Prograf||cap 0.5 mg||00469-0607-67|
|02/01/1996||Tacrolimus||Prograf||1 mg cap||00469-0617-71|
|02/01/1996||Tacrolimus||Prograf||5 mg cap||00469-0657-71|
|02/01/1996||Tacrolimus||Prograf||5 mg/ml cap||00469-3016-01|
|PARENTERAL FORMULAE AND PARENTERAL SUPPLIES|
|Return to Table of Contents|
|07/27/1992||Parenteral nutrition solution; carbohydrates (Dextrose), 50% or less (500 ml = I Unit) - Homemix||B4164|
|07/27/1992||Parenteral nutrition solution; Amino Acid, 3.5%, (500 ml = I Unit) - Homemix||B4168|
|07/27/1992||Parenteral nutrition solution; Amino Acid, 5.5% through 7%, (500 ml = I Unit) - Homemix||B4172|
|07/27/1992||Parenteral nutrition solution; Amino Acid, 7% through 8.5%, (500 ml = I Unit) - Homemix||B4176|
|07/27/1992||Parenteral nutrition solution; Amino Acid, greater than 8.5% (500 ml = I Unit) - Homemix||B4178|
|07/27/1992||Parenteral nutrition solution; carbohydrates (Dextrose), greater than 50% (500 ml = I Unit) - Homemix||B4180|
|07/27/1992||Parenteral nutrition solution; Lipids, 10% with administration set (500 ml = I Unit)||B4184|
|07/27/1992||Parenteral nutrition solution, Lipids, 20% with administration set (500 ml = I Unit)||B4186|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 10 to 51 Grams of protein - Premix||B4189|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, 52 to 73 Grams of protein - Premix||B4193|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, 74 to 100 Grams of protein - Premix||B4197|
|07/27/1992||Parenteral nutrition solution: compounded amino acid and carbohydrates with electrolytes, trace elements and vitamins, including preparation, any strength, over 100 Grams of protein - Premix||B4199|
|07/27/1992||Parenteral nutrition; additives (vitamins, trace elements, heparin, amino acid and electrolytes) homemix, per day||B4216|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - (Aminosyn-RF, NephrAmine, RenAmine) - Premix (per liter)||B5000|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, renal - (Freamine HBC, HepatAmine) - Premix (per liter)||B5100|
|07/27/1992||Parenteral nutrition solution; compounded amino acid and carbohydrates with electrolytes, trace elements, and vitamins, including preparation, any strength, stress - (Branch Chain Amino Acids) - Premix per liter)||B5200|
Future additions to this list will be published in Medicaid Update. Questions regarding adding drugs to this list may be addressed to Health Systems Management at (518) 474-1988. Questions regarding submission of pharmacy claims may be addressed to Computer Sciences Corporation (CSC) at 1-800-522-5535.
LAWSUIT BILLING INFORMATION
NYCHHC et, al. v. BANE
(Medicare Crossover Lawsuit)
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These instructions apply only to those providers who are named plaintiffs in the above-cited action.
- This article is to once again remind providers that all edit correction and data submission opportunities ended with the May 11, 1999 deadline.
- In the April 1999 Medicaid Update, providers were told that the June 1999 purge cycle would be the final cycle in which Medicare lawsuit claims would be processed for payment. At that time, it was anticipated that the purge run would occur in cycle #138. The June purge cycle occurred instead, in cycle #139.
- Providers were also told in a note in the April Medicaid Update that all unresolved lawsuit claims remaining after the June purge cycle would be denied and reported out in remittances, in a regular cycle soon after that purge cycle.
- Please Note: Unresolved Medicare lawsuit claims described above, were denied in cycle #140, and are being reported out to providers in remittances from that cycle.
- Providers may, however, still submit voids for processing, if necessary.
For assistance, please call your Computer Sciences Corporation (CSC) Healthcare Systems representative at:
Practitioner Services: 1-800-522-5518 or  447-9860
Institutional Services: 1-800-522-1892 or  447-9810
Professional Services: 1-800-522-5535 or  447-9830
The Medicaid Update: Your Window Into The Medicaid Program
The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.
Please send suggestions to the editor, Timothy Perry-Coon:
NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm