Medicaid will pay for medically necessary services. A copay is required unless the member is exempt.
Is Prior Authorization required for some services?
Payment is fee for service. Many services require prior authorization. Prior Authorized Service Codes are indicated on the Fee Schedule Web page.
For previous versions of the Physician Fee Schedule or the Physician Injectable Drug List (PIDL) schedule, refer to the Archive Fee Schedule Section below.
||Physician Provider Updates
Attention Providers: Policy Clarification Updates
Notice regarding Omontys Recall
Note: 02/24/2013: FDA is alerting health care providers and patients of a voluntary nationwide recall of ALL lots of Omontys Injection by Affymax and Takeda Pharmaceuticals. The recall is due to reports of anaphylaxis, some fatal. Omontys is used to treat anemia in adult dialysis patients. Until further notice, health care providers should stop using Omontys and return the product to Takeda. For details, please visit the FDA page and the Takeda/Affymax News Release.
Attention Providers who bill paper, professional crossover claims.
The Medicare Coding Sheet has been revised. You may obtain the newest revision at Kentucky Medicaid Management Information System along with the updated billing instructions. For question, please contact Provider Inquiry at 800-807-1232
Physician Pricing Update
The procedure code J7300 new pricing will be $645.84 with an effective date of 7-1-11. This change has been made on the physicians fee schedule located on the fee and rate schedule page.
Physician Provider Update
ESSURE In-Office Placement
Effective Date of Service (DOS) Jan. 1, 2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400 for Place of Service (POS) 11 (office). Physicians can continue to bill 58565 for the placement of the product and payment will remain at $338.62. These two codes must be billed on the same DOS and supporting documentation retained in the patient's chart for placement of product. Prior Authorization will continue to be required.
If 58565 is billed with Place of Service (POS) 22, the payment for the profession fee will be $338.62.
Physician Update as of June 2011
Refer to the Physician NDC Code Update for changes in billing.
||If you have questions:
Regarding policy, contact:
Division of Provider Operations
Physicians and Individual Providers Branch
275 E. Main St., 6W-D
Frankfort, KY 40621
Phone: (502) 564-6287
Email: CHFS DMS Webmaster
Regarding billing, contact HP at 1 (800) 807-1232 or visit the website
Regarding members, contact Member Services at 1 (800) 635-2570
Regarding prior authorization, contact SHPS at 1 (800) 292-2392
Regarding Provider Enrollment, contact Provider Enrollment at 1 (877) 838-5085 or visit the website.
||Archive Fee Schedules
Physician Fee Schedules
Physician Injectable Drug List (PIDL) Updates
Physician NDC to HCPCS Crosswalk Codes
NDC to HCPCS Crosswalk Codes Excel - PDF