Notices & Announcements

NEW **Attention WV Medicaid Medical FFS Providers**

Kepro is currently in the process of updating the Medical Provider contact listing. This update is to ensure Medicaid FFS Providers stay up-to-date with upcoming Kepro announcements and trainings. Please go to https://survey.alchemer.com/s3/6268630/Kepro-Medical-Provider-Contact-Information-Update and complete the contact form at your earliest convenience.

 

New***Attention Podiatry providers: BMS Podiatry Billing Codes Update:

Effective 04/01/2021, the specialty of Podiatry was added to the following HCPCS/CPT codes:

  • HCPCS codes: J1955, J3411, J3415, J3420, G0283,
  • CPT codes: 96372, 97016, 97032 & 97150

Adult Dental Providers- Additional Training Announcement NEW***

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** WV Medicaid has released documents pertaining to the Substance Use Disorder Waiver. As of July 1, 2018, Phase 1 and Phase 2 of the waiver are active. In addition to the announcement letter, adult residential rates are listed below along with the Peer Recovery memorandum. The link to enrolling in the Public LMS Course DHHR provides info on accessing the Peer Recovery Certification Webinar

BMS SUD Waiver Adult Residential Treatment Services Rates Memorandum

DHHR Press Release 2018-6-28 Second Phase of SUD Services Implemented

Instructions for enrolling in Public LMS Course DHHR

Peer Recovery Support Webinar Memorandum 7.11.18

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.

NEW*** Per the 2019 Current Procedural Coding Expert manual, codes 96101, 96111, 96118, and 96120 were closed effective December 31, 2018. WV Medicaid is adding the replacement codes for each closed service. In the interim, KEPRO will continue to accept the closed codes for prior authorization. While authorizations issued under the 96101, 96111, 96118, and 96120 with dates of service after December 31, 2018 will be accepted, they will not be billable to the claims payer. Authorizations will require adjustment when all codes have been updated. Further communication will occur when changes are finalized. 

NEW*** FAQ - Frequently Asked Questions

Question: Can LICSW’s and LPC’s sign treatment plans for LBHC services?

  • Yes, in certain circumstances. Treatment plans for Assertive Community Treatment and Community Psychiatric Supportive Treatment continue to require a physician or psychologist's signature. In addition, the physician, PA, APRN, or licensed or supervised psychologist must be present in-person or by Telehealth and participate in all service planning sessions for members who meet any of the following criteria:
  • Receive psychotropic medications prescribed by the agency;
  • Have a diagnosis of major psychosis or major affective disorder;
  • Have an Intellectual/Developmental Disability (I/DD) Diagnosis;
  • Have an Autism Diagnosis;
  • Have major medical problems in addition to major psychosis and medications; or
  • The presence of the physician, PA, or APRN has been specifically requested by the case manager or the member.

**NEW** SUD Waiver Transition for WV Medicaid MCO Members

Effective July 1, 2019, Substance Use Disorder Waiver Services for WV Medicaid MCO members will be submitted directly to MCO’s. Below are details related to existing authorizations and submission timelines.    

  • KEPRO will accept submissions for SUD Waiver services (Adult Residential Services and Peer Recovery Support Services) through 5:00 p.m., July 1, 2019. Requests must have a service start date prior to July 1, 2019. This date will allow any June 29-30 weekend admissions to be accepted/reviewed by KEPRO.
  • Requests submitted after 5:00 p.m. on July 1, 2019, and those with start dates of July 1, 2019, or later will be closed with a notation advising the provider to submit to the appropriate MCO.
  • MCO’s will accept requests for prior authorization for SUD Waiver services retrospective or current on July 1, 2019.
  • KEPRO will provide current and historical SUD authorizations to the MCO’s on July 3, 2019.
  • Active authorizations on July 1, 2019, will be honored by MCO’s. 

Medical Services Announcements

NEW*** The West Virginia Department of Health and Human Resources (DHHR) and Bureau of Medical Services (BMS) are 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 in 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.

 

NEW***Substance Use Disorder (SUD) Training

The Bureau for Medical Services is pleased to announce upcoming SUD training to be held in conjunction with the Spring Molina Provider Workshops. The SUD training will address components of the WV Medicaid SUD Waiver Manual including information on ASAM and residential levels of care. The SUD training will occur following the morning Molina Workshops. If you intend to participate in both trainings, please make sure you register for each one individually.

Complete the attached registration form and indicate which SUD training session you will attend, along with the number of attendees from your organization.  Forms should be returned to the contact information located at the bottom of the page. Registration must be received by April 9, 2018.

SUD Registration Form

You may review Chapter 504 - Substance Use Disorder Manual at this web address: http://dhhr.wv.gov/bms/Pages/Chapter-504-Substance-Use-Disorder-Services.aspx

For more information on the morning Spring Molina Provider Workshop, please visit the Molina Website at https://www.wvmmis.com or email the Molina Provider Field Representatives at WVProviderFieldRepresentative@molinahealthcare.com

2018 Spring Provider Workshop Registration link: 

https://www.surveymonkey.com/r/2018SpringProviderWorkshops

 

Newly Released Documents

BMS SUD Waiver Adult Residential Treatment Services Rates Memorandum

DHHR Press Release 2018-6-28 Second Phase of SUD Services Implemented

Instructions for enrolling in Public LMS Course DHHR

Peer Recovery Support Webinar Memorandum 7.11.18

 

New Announcement

Per BMS ATTENTION Policy Revision:  DMEPOS Providers:

  • Effective January 1, 2021, providers will no longer be required to obtain a physician (MD or DO) signature on a face-to-face encounter when covered DMEPOS items are ordered by a PA, NP, or CNS.

 

New Announcement**

Dental Provider Announcement

Unlisted CPT code 41899

Effective October 1, 2019, all unlisted CPT/HCPCS codes require authorization regardless of the place of service.  An updated Master Code list that includes these unlisted codes has been added to KEPRO’s provider website: http://wvaso.kepro.com.

When dental services are performed in a hospital setting, the facility will submit claims to BMS’ current claims vendor, DXC Technology, for the usage of the operating room with CPT code 41899. CPT code 41899 is an unlisted CPT code and prior authorization is now required.  Dental Providers must fax an Outpatient (OP) surgery request form filled out in its entirety for clinical review to 844-633-8427.  This fax number is also shown on the top of the request form.  This must be done for all dental services performed in a hospital setting whether or not the dental procedure requires prior authorization. The dental procedure to be performed should be indicated on the request for 41899.

KEPRO’s DDE Provider portal does not have an option for a dental provider to submit an OP surgery request so requests for 41899 should be faxed. The faxed authorization request received will be keyed by KEPRO staff under the hospital facility. The requesting Dental Provider will not have access to these authorization requests.  As a courtesy to Dental Providers, KEPRO staff will fax determinations to the fax number indicated by the Dental Provider on the request form for CPT code 41899 only.  The process for Dental Providers to obtain authorization for dental services billed with CDT (dental) codes that require prior authorization has not changed.

For additional information, please access KEPRO’s provider website http://wvaso.kepro.com or contact KEPRO-Medical Unit at 800-346-8272 for assistance. Please see the attached letter sent at the request of the Bureau of Medical Services regarding rate reimbursement changes for Private Duty Nursing. Please direct questions to the Bureau for Medical Services.

***NEW   PDN Rate Reimbursement:  Please see the attached letter sent at the request of the Bureau of Medical Services regarding rate reimbursement changes for Private Duty Nursing. Please direct questions to the Bureau for Medical Services.

PDN Announcement from BMS

Attention Nursing Home Providers - Atrezzo Training Registration

Atrezzo Memo  02.3.2021

Announcement re: Constitutional Amendment 1- on behalf of the West Virginia Bureau for Medical Services (BMS)

Below please find Public Notice information related to recently passed West Virginia Constitutional Amendment 1. The link for further information is: https://dhhr.wv.gov/bms/Public%20Notices/Pages/Public%20Notice%20regarding%20West%20Virginia%20Constitutional%20Amendment%201%20is%20now%20available.aspx

Also attached is the new certification form for your reference and use.

BMS Physician Certification for Pregnancy Termination Form

Public Notice regarding West Virginia Constitutional Amendment 1 is now available.

PUBLIC NOTICE

WEST VIRGINIA MEDICAID PROGRAM

REGARDING: WEST VIRGINIA CONSTITUTIONAL AMENDMENT 1

INITIALLY ISSUED: NOVEMBER 9, 2018

AMENDED: NOVEMBER 13, 2018

On November 6, 2018 West Virginia voters ratified West Virginia Constitutional Amendment 1, which states: “Nothing in this Constitution secures or protects a right to abortion or requires funding of abortion.” This amendment in turn abrogated the holding by the West Virginia Supreme Court in Women’s Health Center of West Virginia, Inc. v.Panepinto (1993) that West Virginia Code §9-2-11, which limits Medicaid funds paying for pregnancy terminations to several limited circumstances, is unconstitutional.

As a result of the ratification of this Constitutional Amendment as described above, effective November 6, 2018 at 7:30 PM, the West Virginia Bureau for Medical Services will only reimburse providers for pregnancy terminations in the following three circumstances, consistent with W. Va. Code §9-2-11:

  • If, on the basis of the physician’s best clinical judgment, there is a medical emergency that so complicates a pregnancy as to necessitate an immediate abortion to avert the death of the mother or for which a delay will create grave peril of irreversible loss of major bodily function or an equivalent injury to the mother: Provided, That an independent physician concurs with the physician’s clinical judgment;
  • If, on the basis of the physician’s best clinical judgment, there is clear clinical medical evidence that the fetus has severe congenital defects or terminal disease or is not expected to be delivered; or
  • If the individual is a victim of incest or the individual is a victim of rape when the rape is reported to a law enforcement agency.

If there are any questions, please contact the West Virginia Bureau for Medical Services at (304) 558-1700.