Jan 1, 2008 - Department of Social Services. Medical Care Administration. 25 Sigourney Street. Hartford, CT 06106-5033. Policy Transmittal 2008-20.
State of Connecticut Department of Social Services Medical Care Administration 25 Sigourney Street Hartford, CT 06106-5033 Policy Transmittal 2008-20 October 2008
PB 2008-52
Contact: Timothy Bowles 860-424-4984 _______________________ Michael P. Starkowski Commissioner TO: SUBJECT:
January 1, 2008 Effective Date
Physicians, Nurse Practitioners, Nurse-Midwives, Podiatrists, Optometrists, and Managed Care Organizations Physician Fee Schedule: Incorporation of January 2008 Healthcare Common Procedure Coding System (HCPCS) Changes and Allowed Amount Changes for Certain Physician Administered Drugs
The Department of Social Services is incorporating the January 2008 HCPCS changes (addition, deletions and description changes) in its Physician Fee Schedule under the Medicaid fee for service program retroactively effective for dates of service on or after January 1, 2008. Discontinued 2008 HCPCS codes will be discontinued effective with dates of service October 1, 2008 forward. The Department is making these changes to ensure that its physician fee schedule remains compliant with the Health Insurance Portability and Accountability Act. Physician Administered Drugs In addition, please be advised that the Department is making pricing adjustments retroactive to January 1, 2008 to certain physician administered drugs (J-codes), including increased allowed amounts as shown in the following chart. If applicable, paid claims for dates of service on or after January 1, 2008 will be adjusted to reflect the fee increases. You will not need to resubmit claims if your original submitted charge is greater than or equal to the new rate. Providers will be notified by EDS when the adjustment will occur. J7319 J3140 J0200 J0350 J0380 J0390 J0395 J0520 J0620 J0710 J0900
$ 134.40 $ 0.36 $ 17.03 $ 2,410.24 $ 1.14 $ 17.61 $ 163.20 $ 4.78 $ 11.64 $ 1.39 $ 1.46
J2910 J2940 J2995 J3110 J3150 J3280 J3310 J3350 J3400 J3520 J7130
$ $ $ $ $ $ $ $ $ $ $
24.99 44.94 77.09 8.28 0.84 3.88 6.38 75.55 11.05 0.74 0.37
J7637 J7638 J7640 J7641 J7642 J7643 J7645 J7647 J7648 J7649 J7650
$ $ $ $ $ $ $ $ $ $ $
0.06 0.13 1.29 0.21 1.04 0.97 0.21 0.72 0.61 0.32 0.16
J1055 J1056 J1180 J1320 J1324 J1330 J1452 J1562 J1675 J1700 J1710 J1810 J1825 J1890 J1960 J2170 J2513 J2670 J2725
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $
66.97 22.02 8.07 2.24 22.96 4.08 850.00 12.75 1.14 1.10 4.98 14.39 396.48 9.18 0.38 11.48 12.98 3.51 21.83
J7191 J7300 J7302 J7303 J7304 J7306 J7607 J7609 J7610 J7615 J7622 J7624 J7627 J7628 J7629 J7633 J7634 J7635 J7636
$ 1.87 $ 350.12 $ 468.71 $ 37.32 $ 14.65 $ 507.50 $ 0.99 $ 0.07 $ 0.10 $ 1.39 $ 0.04 $ 1.21 $ 0.17 $ 0.23 $ 0.18 $ 4.54 $ 2.30 $ 0.12 $ 0.12
J7657 J7658 J7659 J7660 J7667 J7668 J7670 J7680 J7681 J7683 J7684 J7685 J8565 J8600 J8650 J9165 J9215 J9270 J9357
$ 6.51 $ 6.51 $ 6.56 $ 6.56 $ 0.22 $ 0.87 $ 0.24 $ 0.01 $ 0.01 $ 0.10 $ 0.17 $ 57.31 $ 57.87 $ 4.01 $ 17.00 $ 12.89 $ 7.31 $ 83.93 $ 471.24
Please note in particular changes to the following: J1055 Injection, medroxyprogesterone acetate for contraceptive use, 150 mg J7300 Intrauterine copper contraceptive J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg
@ $ 66.97 @ $ 350.12 @ $ 468.71
Vaccinations The allowed amount has also been increased for: 90649 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use @ $ 126.42 Reimbursement for Developmental Screening The Department recognizes that early identification of children with developmental delays or disabilities can lead to treatment of, or intervention for, a disability and lessen its impact on the functioning of the child and family. Accordingly, reimbursement for developmental screening (procedure code 96110; allowed charge $ 18.00) is now available on the same day as a routine office visit or well-care/EPSDT visit, effective for dates of service July 1, 2008 and forward. The American Academy of Pediatrics recommends that providers use validated tools for developmental screening at the 9, 18 and 30 month well-care/ESPDT visits, or at any other time that a parent or provider has concerns. The Department’s EPSDT schedule provides for well child visits at 9, 18 and 24 months. Until the 30 month well-care/EPSDT visit is added to the Department’s EPSDT schedule, providers may perform the routine developmental screening at the 24 month visit.
Several validated developmental screening tools are available for a range of ages. For your convenience, you may find a list of available developmental screening tools and a description of each at http://www.medicalhomeinfo.org/screening/DPIP/screeningtoolgrid.pdf. Effective January 1, 2008, the above changes also apply to physician, nurse practitioner, nursemidwife, podiatrist, and optometrist services reimbursed under the State Administered General Assistance program. Effective January 1, 2008, physician, nurse practitioner, nurse-midwife, podiatrist, and optometrist services fees reimbursed under HUSKY A, HUSKY B, or Charter Oak Health Plan may be no less than the new fees established pursuant to this transmittal. Access for Baby Care (“ABC”) for Early Examination and Fluoride Varnish Placement Effective for dates of service November 1, 2008 and forward, two (2) dental codes will be added to the Medicaid Physician Fee Schedule for the “ABC Program”. These codes allow primary care providers who have attended the ABC Program Continuing Medical Education course to place the aforementioned codes on the CMS 1500 for reimbursement of services for each well child visit up to forty (40) months of age. D0145
Oral evaluation for a patient under three (3) years of age and counseling with the primary caregiver. @ $ 25.00
D1206
Topical therapeutic fluoride varnish application for moderate to high caries risk patients. @ $ 20.00
The fee schedule is available on the Connecticut Medical Assistance Program Website: www.ctdssmap.com. From the Home page, go to “Publications,” then to “Provider,” then to “Provider Fee Schedule Download” then to "Physician" for January 1, 2008. Posting Instructions: www.ctdssmap.com.
Provider transmittals can be downloaded from the EDS web site at
Distribution: This policy transmittal is being distributed to holders of the Connecticut Medical Assistance Program Provider Manual by Electronic Data Systems. Managed Care Organizations are requested to send this bulletin to their network providers and subcontractors. Responsible Unit: DSS, Medical Care Administration, Medical Policy Section; Timothy Bowles, Lead Planning Analyst, (860) 424-5486. Date Issued: October 2008
