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Notices & Announcements

Behavioral Health Program Announcement:

New** As of January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) annual updates have resulted in changes to drug testing codes utilized by WV Medicaid. The Bureau for Medical Services (BMS) will follow the 2017 CMS coding guidelines for reporting drug testing procedures:

  • Presumptive testing codes 80305, 80306 and 80307 should be used instead of G0477, G0478, and G0479.
  • Only one of the three presumptive codes (80305, 80306, 80307) may be billed per day.
  • Only one of the four definitive codes (G0480, G0481, G0482, G0483) may be billed per day.
  • Only one service unit per procedure code per date of service may be billed when submitting (80305-80307, G0480-G0483, G0659)
  • Drug confirmation tests are no longer eligible to be separately reported under any procedure code, unlisted or otherwise. This service is considered included in the presumptive or definitive drug testing procedure codes (80305-80307, G0480-G0483, G0659)
  • Specimen validity testing is not eligible to be separately billed under any procedure code. The code description for (80305-80307, G0480-G0483, G0659) indicates that this testing is included if it was performed.

BMS policy requires a prior authorization for drug screenings performed for over the limit of 24 per calendar year. The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment (e.g. Suboxone).

The presentation on the 2017 Drug Testing Changes can be found here: 2017 Drug Codes Changes Webinar Presentation

New** The West Virginia Department of Health and Human Resources (WV DHHR) along with the Bureau for Medical Services (BMS) is pleased to announce West Virginia Licensed Professional Counselors (LPC) may enroll as Medicaid Providers beginning Mar 1, 2017. The following services have been approved by West Virginia Medicaid for LPCs to provide:

  • Psychiatric Diagnostic Evaluation without Medical Services (90791)
  • Individual Psychotherapy (90832, 90834, 90837)
  • Group Psychotherapy (90853)
  • Psychotherapy for Crisis (90839, 90840)
  • Family Psychotherapy (90846, 90847)

A draft manual is in development and will be posted on the BMS website for public comment in the near future. More information and registration guidelines will be posted as it comes available. 

New**      Can telehealth be utilized through a personal computer?

BMS’s response:  Yes, as long as the individual’s personal computer has a VPN to the provider and the provider ensures that it is safe to render services through this modality for the member.

 

Medical Services Announcements:

  • KEPRO Modification Procedure Announcement
  • ICD-10 V. 1CD 9 Announcement
  • New**  As of January 1, 2017, the Centers for Medicare and Medicaid Services (CMS) annual updates have resulted in changes to drug testing codes utilized by WV Medicaid. The Bureau for Medical Services (BMS) will follow the 2017 CMS coding guidelines for reporting drug testing procedures:

    • Presumptive testing codes 80305, 80306 and 80307 should be used instead of G0477, G0478, and G0479.
    • Only one of the three presumptive codes (80305, 80306, 80307) may be billed per day.
    • Only one of the four definitive codes (G0480, G0481, G0482, G0483) may be billed per day.
    • Only one service unit per procedure code per date of service may be billed when submitting (80305-80307, G0480-G0483, G0659)
    • Drug confirmation tests are no longer eligible to be separately reported under any procedure code, unlisted or otherwise. This service is considered included in the presumptive or definitive drug testing procedure codes (80305-80307, G0480-G0483, G0659)
    • Specimen validity testing is not eligible to be separately billed under any procedure code. The code description for (80305-80307, G0480-G0483, G0659) indicates that this testing is included if it was performed.

    BMS policy requires a prior authorization for drug screenings performed for over the limit of 24 per calendar year. The HF modifier must continue to be included on all claims for these codes when related to substance abuse treatment (e.g. Suboxone).

    The presentation on the 2017 Drug Testing Changes can be found here: 2017 Drug Codes Changes Webinar Presentation

  • Durable Medical Equipment (DME) Providers: KEPRO will accept requests for Nebulizers for children under the age of 3 via phone review. According to BMS policy, prior authorization is required and will offer the phone review option only with requests for nebulizers for children under age 3. Please call 1-800-346-8272 to initiate a C3 authorization or with any questions or issues regarding these requests.
  • Outpatient Surgery Services: For all outpatient procedures, where an assistant surgeon is indicated, please be sure to indicate this in your request. If not, a modification will need to be done, prior to billing, as the claim will not pay. For billing purposes, you will need to bill with the appropriate modifier as well. For outpatient procedures, where a co-surgeon is indicated, both surgeons will need an authorization. Please note Medicaid follows Medicare guidelines for determination in appropriateness for an assistant surgeon.
  • New**  The West Virginia Department of Health and Human resources (DHHR) and Bureau of Medical Services (BMS) is pleased to announce the statewide expansion of the first West Virginia Health Homes Program serving members with bipolar disorder with at risk for Hepatitis B and/or C. This expansion, Health Homes 2, will begin April 2017.
  • New**  Beginning April 2017, a new program, Health Homes Program 3, will be implemented to serve members with pre-diabetes, diabetes, or obesity, and at risk for anxiety and/or depression.  This program will be piloted in the following 14 counties: Boone, Cabell, Fayette, Kanawha, Lincoln, Logan, Mason, McDowell, Mercer, Mingo, Putnam, Raleigh, Wayne and Wyoming.
  • WV DHHR Health Homes Provider Letter
  • WV DHHR Health Homes Face to Face and Webinars Announcement and Schedule

 

  • New**   Genetics-CFTR 2017 Announcement

    Effective January 1, 2018 CPT codes 81220-81223 will require prior authorization for WV Medicaid Members. The provider must establish medical necessity by meeting the review criteria set by BMS to receive approval for these codes. 

    81220- CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; common variants (e.g., ACMG/ACOG guidelines)

    81221- CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; known familial variants

    81222- CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; duplication/deletion variants

    81223- CFTR (cystic fibrosis transmembrane conductance regulator) (e.g., cystic fibrosis) gene analysis; full gene sequence

    WV Medicaid will not be approving requests for 81220 for cystic fibrosis screening in the general population.  However, this code maybe considered medically necessary as a diagnostic test following abnormal newborn screening or in children with clinical features suggestive of cystic fibrosis.

    Providers must seek prior authorization through KEPRO’s C3 Provider Portal. If you currently do not have access to the web-based portal, please contact KEPRO at http://wvaso.kepro.com or 1-800-346-8272 for registration information, or register via the online portal at https://c3wv.kepro.com.

    WV Medicaid considers a core panel of 25 mutations that are recommended by the American College of Medical Genetics (ACMG) medically necessary for cystic fibrosis genetic testing.  WV Medicaid considers screening for cystic fibrosis mutations that extend beyond the standard mutation panel recommended by the ACMG to be experimental and investigational.