WSR 12-14-082



[ Filed July 2, 2012, 2:31 p.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).


Legal and Administrative Services

Document Title: Provider Notice #12-44.

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

Effective Date: July 1, 2012.

Specific changes to the guide include:

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

For additional information, contact Amber Dassow, HCA, phone (360) 725-1349, TDD/TTY 1-800-848-5429, e-mail, web site

Washington State Code Reviser's Office