Nevada Medicaid

Clinical Claim Editor is Now Part of the Claim Adjudication Process [See Web Announcement 247]

New Diabetic Supply Program effective March 1, 2009 [Read more]

Monthly Conference Call for Behavioral Health Providers [Details]

Web Announcement 258

Attention Provider Types 20, 24 and 77: New CPT Codes for Neonatal and Infant Care

Effective immediately, the following new Common Procedural Terminology (CPT) codes for neonatal and infant care services can be billed with dates of service on and after Jan. 1, 2009:

• 99469 – Subsequent inpatient neonatal critical care, per day, for the evaluation and management of a critically ill neonate, 28 days of age or less.
• 99479 – Subsequent intensive care, per day, for the evaluation and management of the recovering low birth weight infant (present body weight of 1500-2500 grams).

Any claims for these codes submitted and denied with dates of service on and after Jan. 1, 2009, will be reprocessed. Providers will be notified when the affected claims are reprocessed.

Web Announcement 257

Attention Provider Type 33 and Other Providers Who Bill DME and Supplies: A Policy Refresher on DMEPOS Prescription/Order Requirements

A prescription/order for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) requires the following components, at a minimum:

• Recipient’s name
• Physician’s/Practitioner’s name
• Clearly specified start date
• Length of need
• Detailed product description
• Physician’s/Practitioner’s signature and date

Please refer to the Nevada Medicaid Services Manual (MSM) Chapter 1300-Durable Medical Equipment for more detailed requirements for verbal and written orders.

Web Announcement 256

Update on 2009 CPT and HCPCS Codes: Phase II Codes Updated in MMIS

Phase II of the 2009 Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes have been updated in the Medicaid Management Information System (MMIS). Effective immediately, Phase II codes 82375, J1750 and J7611-J7614 are available for reimbursement with dates of service on and after Jan. 1, 2009.

Any claims for these codes submitted and denied with dates of service on and after Jan. 1, 2009, will be reprocessed. Providers will be notified when the affected claims are reprocessed.

Reminder for provider types 12, 14, 17, 20, 21, 22, 24, 25, 27, 29, 36, 45, 64, 72, 74 and 77: National Drug Code (NDC) and NDC quantity must be billed for physician/outpatient-facility administered drugs.

Web Announcement 255

Attention Provider Type 33: CMS Quarterly Update Adds HCPCS Labor Codes for DME Repairs

The Centers for Medicare & Medicaid Services (CMS) quarterly update effective April 1, 2009, added the following Healthcare Common Procedure Coding System (HCPCS) labor codes for the repair or non-routine service of Durable Medical Equipment (DME):

• K0739 – Repair or non-routine service for DME other than oxygen, requiring the skill of a technician, labor component, per 15 minutes.
• K0740 – Repair or non-routine service of oxygen equipment, requiring the skill of a technician, labor component, per 15 minutes.

Note: For Nevada Medicaid, code K0740 is non-covered. Labor billing code selection for Medicaid should follow Medicare guidelines.

Nevada Medicaid/Nevada Check Up claims for code K0739 already submitted and denied with dates of service on or after April 1, 2009, will be reprocessed. Providers will be notified when the affected claims are reprocessed.

For dates of service prior to April 1, 2009, use labor code E1340 – repair or nonroutine service for DME, labor component, per 15 minutes. E1340 is no longer covered effective with dates of service on or after April 1, 2009, and will be removed from the next revision of the DMEPOS Fee Schedule.

Web Announcement 254

Attention Provider Type 33 and Other Providers Who Bill DME and Supplies: Maximum Limits Set on Certain Items

Effective with dates of service on and after March 11, 2009, the Division of Health Care Financing and Policy (DHCFP) has set maximum service limits on the following Healthcare Common Procedure Coding System (HCPCS) codes for Durable Medical Equipment (DME) and supplies:

Code	Description	Limit
A4927	Gloves, non sterile, 100/box (1 box = 1 unit)	8 units per month
A4930	Gloves, sterile, per pair	20 units per month
A5500	Diabetic shoe custom preparation and supply of off-the shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe	1 unit per foot per calendar year
A5513	Diabetic multiple density insert, custom molded, each	1 unit per foot per month, max 6 units per year
A6456	Zinc paste impregnated bandage, non-elastic, per yard	2 units per month
A6530	Gradient compression stocking, below knee, each	1 unit per leg per 6 months
A7000	Canister, disposable, used with suction pump, each	10 units per month
L3332	Lift, elevation, inside shoe, tapered, up to one-half inch	1 unit per foot per calendar year

For the above codes A5500, A5513 and A6530: When the same code is billed for bilateral items (left and right) on the same date of service, the items must be billed on separate claim lines using the “LT” or “RT” modifiers and 1 unit of service per line. This does not apply to Medicare crossover claims.

These limits will be added to the next revision of the DMEPOS Fee Schedule.

Web Announcement 253

Important Notice Regarding Procedure Codes No Longer Covered and Changes to Code 41899

The Division of Health Care Financing and Policy (DHCFP) has determined that changes to certain procedure codes will promote the use of uniform language to describe medical, surgical and diagnostic services and provide fiscal savings for Nevada Medicaid/Nevada Check Up. The following changes are effective with dates of service on and after April 1, 2009.

• The procedure codes listed on the attached document are no longer covered by Nevada Medicaid/Nevada Check Up. Providers are urged to use codes that are more specific to the procedures being billed.
• Code 41899 (Dental Surgery Procedure) is covered only for provider types 10 (Outpatient Surgery, Hospital Based) and 46 (Ambulatory Surgery Centers). The ASC Payment Group for code 41899 has been changed from AS7 to AS1, because the code is used for routine dental services.

Web Announcement 252

Prior Authorization Policy for Psychotropic Drugs for Children and Adolescents

Effective April 15, 2009, Nevada Medicaid policy goes into effect requiring prior authorization (PA) for all psychotropic medications prescribed for the following children and adolescents:

• All recipients ages 5 years and younger.
• Recipients ages 6 through 17 when more than one medication is prescribed from within the same class within the same 30-day period or when three or more psychotropic medications are prescribed (regardless of therapeutic class) within the same 30-day period.

Provider types 20 (Physician, M.D., Osteopath) and 28 (Pharmacy) are affected by this policy.

When a PA is needed for psychotropic agents for children and adolescents, prescribing physicians must use form FH-70, which is posted on this website (select “Forms” from the "Providers" or "Pharmacy” menus). Refer to the Nevada Medicaid Services Manual, Chapter 1200, Appendix A, for the policy regarding this requirement.

CPT codes, descriptions and other data only are copyright © 2008 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. CPT is a registered trademark ® of the American Medical Association.

Current Dental Terminology, fourth edition (CDT) (including procedure codes, definitions (descriptors) and other data) is copyrighted by the American Dental Association. © 2008 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.