WASHINGTON STATE REGISTER

WSR 12-14-082

INTERPRETIVE OR POLICY STATEMENT

HEALTH CARE AUTHORITY

[ Filed July 2, 2012, 2:31 p.m. ]

Notice of Interpretive or Policy Statement

аааа 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

аааа Document Title: Provider Notice #12-44.

аааа Subject: Physician-related services/healthcare professional services medicaid provider guide.

аааа Effective Date: July 1, 2012.

аааа Specific changes to the guide include:

Х Update to CPT codes for prolonged care and oral maxillofacial surgery.

Х Add new section for "dental services billable by primary care medical provider."

Х Add new limits to "vision coverage table" for codes 92071 and 92072.

Х Move all instructions regarding mental health to a new Mental Health for Children, Psychiatric and Psychological Services Medicaid Provider Guide.

Х Add prior authorization (PA) requirement to procedure codes for spinal cord stimulation and pain management.

Х Clarify that providers are eligible to receive enhanced rates for trauma care services provided to managed care enrollees, beginning July 1, 2012.

Х Add procedure code S3854 to cover genetic counseling and genetic testing.

Х Clarify physician assistants-certified billing for assisting in C-section.

Х Update with information regarding agency review for medical necessity for hysterectomies in certain cases.

Х Add procedure codes for services that require PA.

Х Clarify information for requesting PA for intensity-modulated radiation therapy.

Х Add PA requirements to procedure codes for spinal cord stimulation for chronic pain.

Х Add Q2047 to the list of miscellaneous drugs that require PA.

Х Replace J3490 with J0897 the "list of miscellaneous drugs that require PA."

Х Revise information regarding modifiers 57, 59, and 80.

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

Х	Update to CPT codes for prolonged care and oral maxillofacial surgery.
Х	Add new section for "dental services billable by primary care medical provider."
Х	Add new limits to "vision coverage table" for codes 92071 and 92072.
Х	Move all instructions regarding mental health to a new Mental Health for Children, Psychiatric and Psychological Services Medicaid Provider Guide.
Х	Add prior authorization (PA) requirement to procedure codes for spinal cord stimulation and pain management.
Х	Clarify that providers are eligible to receive enhanced rates for trauma care services provided to managed care enrollees, beginning July 1, 2012.
Х	Add procedure code S3854 to cover genetic counseling and genetic testing.
Х	Clarify physician assistants-certified billing for assisting in C-section.
Х	Update with information regarding agency review for medical necessity for hysterectomies in certain cases.
Х	Add procedure codes for services that require PA.
Х	Clarify information for requesting PA for intensity-modulated radiation therapy.
Х	Add PA requirements to procedure codes for spinal cord stimulation for chronic pain.
Х	Add Q2047 to the list of miscellaneous drugs that require PA.
Х	Replace J3490 with J0897 the "list of miscellaneous drugs that require PA."
Х	Revise information regarding modifiers 57, 59, and 80.

й Washington State Code Reviser's Office