Web Announcement 476

2012 CPT and HCPCS Codes Available for Billing

The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes have been updated in the Medicaid Management Information System (MMIS).

Effective immediately, the codes listed below can be billed with dates of service on/after January 1, 2012:

15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 15777, 20527, 22633, 22634, 26341, 29582, 29583, 29584, 32096, 32097, 32098, 32505, 32506, 32507, 32607, 32608, 32609, 32666, 32667, 32668, 32669, 32670, 32671, 32672, 32673, 32674, 33221, 33227, 33228, 33229, 33230, 33231, 33262, 33263, 33264, 36251, 36252, 36253, 36254, 37191, 37192, 37193, 37619, 38232, 49082, 49083, 49084, 62369, 62370, 64633, 64634, 64635, 64636, 74174, 77424, 77425, 77469, 78226, 78227, 78579, 78582, 78597, 78598, 86386, 87389, 90869, 92071, 92072, 92558, 92618, 93998, 94726, 94727, 94728, 94729, 94780, 94781, 95885, 95886, 95887, 95938, 95939, A5056, A5057, A9584, A9585, E0988, E2358, E2359, E2626, E2627, E2628, E2629, E2630, E2631, E2632, E2633, G0448, G0451, J0131, J0221, J0257, J0490, J0588, J0712, J0840, J0897, J1557, J1725, J2265, J2507, J7131, J7180, J7183, J7326, J7665, J8561, J9043, J9179, J9228, L5312, L6715, L6880.

Effective immediately, the HCPCS codes listed below can be billed with the following dates of service:

• G0444 with dates of service on/after October 14, 2011.
• G0442 and G0443 with dates of service on/after October 17, 2011.
• G0445 and G0446 with dates of service on/after November 8, 2011.
• G0447 and G0449 with dates of service on/after November 29, 2011.

Claims submitted with the dates of service listed above that denied or were cut back because the 2012 codes were not in MMIS will be reprocessed. Providers will be notified when the affected claims are reprocessed.

Web Announcement 475

Submission Process for Inpatient Facilities Requesting Roll Up of Prior Authorization Lines

Attention provider types (PT) 11, 13, 51, 56, 63, 75 and 78: To assist providers in resolving the need to have a prior authorization (PA) “rolled up” in the most efficient manner, HP Enterprise Services (HPES) is manually rolling up PAs until an automated solution is implemented.

A PA requires ”roll up” when the PA lines do not have the same start and end date or have the same revenue code listed on more than one line. Please review the attached full Web Announcement 475 for instructions and additional information.

Web Announcement 474

Providers’ Requests for Reviews of Denied/Reduced Prior Authorizations

As specified in the Billing Manual for Nevada Medicaid and Nevada Check Up, a provider has two options for a prior authorization (PA) to be reviewed if the determination is denied or reduced. The two options are a peer-to-peer review or reconsideration.

Please review the attached full Web Announcement 474 for an explanation of each option. The announcement also lists the procedures to be followed by providers and HP Enterprise Services (HPES).

Web Announcement 473

Urgent: Updates for Provider Types 10, 22, 32, 33, 45 and 46 Regarding Rate Reductions or Retractions

This announcement provides updates regarding previously announced rate reductions for the provider types indicated below. The information in this web announcement supersedes all information in web announcements 408, 421 and 435.

• Provider Type 10: As previously announced, the rate reduction of 15 percent was retracted. Rates were restored to those in effect prior to the August 1, 2011, change. Any claims affected by the prior reduction were reprocessed and the adjudication appears on remittance advices dated November 25, 2011.
• Provider Type 22: Rates were reduced by .7 percent with an effective date of August 1, 2011. Any claims with a date of service from August 1, 2011, to August 8, 2011, were reprocessed at the lower rate. The adjudication of any reprocessed claims was reported on remittance advices dated March 23, 2012.
• Provider Type 32: The previously announced rate reduction of 15 percent has been implemented retroactively to December 6, 2011. Claims affected by the reduction will be reprocessed and the adjudication will appear on a future remittance advice.
• Provider Type 33: Rates were reduced by .7 percent effective August 1, 2011. Any claims with a date of service from August 1, 2011, to August 8, 2011, will be reprocessed at the lower rate. The adjudication of any reprocessed claims will be reported on a future remittance advice.
• Provider Type 45: The previously announced rate reduction of 15 percent has been implemented retroactively to August 1, 2011. Claims affected by the reduction will be reprocessed and the adjudication will appear on a future remittance advice.
• Provider Type 46: The previously announced rate reduction of 15 percent has been implemented retroactively to August 1, 2011. Claims affected by the reduction will be reprocessed and the adjudication will appear on a future remittance advice.

Web Announcement 472

Medicaid Services Manual Updated per April Hearings

The following Nevada Medicaid Services Manual (MSM) chapter changes were approved at recent Division of Health Care Financing and Policy (DHCFP) Public Hearings. Please review the updated MSM chapters on the DHCFP website. The schedule and agendas for future hearings are on the DHCFP’s Public Notices webpage.

• MSM Chapter 100 – Medicaid Program (Changes approved April 10, 2012)
• MSM Chapter 400 – Mental Health and Alcohol/Substance Abuse Services (Changes approved April 10, 2012)
• MSM Chapter 600 – Physician Services (Changes approved April 10, 2012)
• MSM Chapter 1200 – Prescribed Drugs (Changes approved April 17, 2012)

Web Announcement 471

Anesthesia Services Claims Submitted Electronically

Between January 1, 2012, and March 9, 2012, providers who submitted claims for anesthesia services electronically using the Accredited Standards Committee (ASC) X12 Version 5010 Professional Health Care Claim and Encounter 837P format were overpaid if providers billed the services in minutes.

Affected claims will be reprocessed to recoup overpayments. The adjudication of the reprocessed claims will be reflected on a future remittance advice. No action is required by providers.

Effective January 1, 2012, electronic billers using the Version 5010 837P transaction are instructed to bill anesthesia services in units rather than minutes.*

Five procedure codes do not require a minutes-to-units conversion and must be billed in units: 01953, 01967, 01968, 01969 and 01996.

* Converting minutes to units: Per the billing instructions for anesthesia services, 1 unit represents a 15-minute interval. When the minutes are not evenly divisible by 15, they will be rounded up to the nearest whole unit; for example, 16 minutes would be 2 units. Note: These instructions are for electronic claims only.