WSR 12-14-070

INTERPRETIVE OR POLICY STATEMENT

HEALTH CARE AUTHORITY


[ Filed July 2, 2012, 11:12 a.m. ]


Notice of Interpretive or Policy Statement


     In accordance with RCW 34.05.230(12), following is a list of policy and interpretive statements issued by the health care authority (HCA).


HCA

Legal and Administrative Services



     Document Title: Provider Notice #12-38.

     Subject: Prosthetic-orthotic devices medicaid provider guide.

     Effective Date: July 1, 2012.

     Updating the coverage table-


o For consistency with other shoe codes, adding the limit of one pair every twelve months to codes A5501, A5503, A5504, A5505, A5506 (related to shoes for diabetics).
o For consistency with the EPA criteria coding table, adding the limit of one pair of oxford shoes every twelve months to L3215 and L3219.
o Correcting L6700, terminal device hook, by adding prior authorization. (No policy change.)

     Updating instructions for the CMS-1500 Claim Form.

     For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail dassoal@hca.wa.gov, web site http://www.hca.wa.gov/.

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