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Physician Services

Medicaid will pay for medically necessary services. A copay is required unless the member is exempt.

Notice

The Cabinet for Health and Family Services, Department for Medicaid Services Preventive and Wellness Initiative provided enhanced reimbursement rates for certain preventive and wellness services beginning Jan. 1, 2015. In accordance with the Medicaid State Plan and 907 KAR 3:017, this initiative ends June 30, 2016. Starting July 1, 2016, any codes paid at the enhanced rate reverts to those rates listed on the current Kentucky Medicaid Physicians and/or Clinical Diagnostic Laboratory fee schedules.

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 schedule, refer to the Archive Fee Schedule Section below.

Physician Provider Updates

Attention Providers: Policy Clarification Updates

Notice regarding Omontys Recall

Note: Feb. 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 July 1, 2011. 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 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 Policy and Operations
Benefit Policy Branch
275 E. Main St., 6W-D
Frankfort, KY 40621
Phone: 502-564-6890
Email: CHFS DMS Webmaster

Regarding billing, contact HP at 800-807-1232 or visit the website

Regarding members, contact 800-635-2570

Provider Services, contact (855) 824-5615

Regarding prior authorization, contact SHPS at 800-292-2392

Regarding Provider Enrollment, contact Provider Enrollment at 877-838-5085 or visit the website.

Archive Fee Schedules

Physician Fee Schedules

Physician Injectable Drug List (PIDL) Updates

Note: Feb. 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 site and the Takeda/Affymax News Release.

Physician NDC to HCPCS Crosswalk Codes

NDC to HCPCS Crosswalk Codes Excel - PDF

 

Regulations, Provider Letters, Forms, Applications, Billing Information and Publications
 

Regulations

Provider Letters

To view older provider letters, refer to the Provider Letter page.

Forms

  • Map-251 -Hysterectomy Consent Form (rev. 10/2010)
  • Consent for Sterilization Form English

Applications

Billing Information

NDC Information

Physician Injectable Drug List

  • Refer to Fee and Rate Schedules page for the most current PIDL listing
  • PIDL Frequently Asked Questions: PDF
  • PIDL Tutorial: PDF

Publications

  • Fluoride Varnish Manual
  • Image Gently Campaign: DMS wants to encourage our medical community to recognize the importance of radiation safety in pediatric imaging. Visit the Image Gently webpage for more information
 

Last Updated 5/31/2016