[45 Pa.B. 4493]
[Saturday, August 8, 2015]
[Continued from previous Web Page]
Year Code
CitationSubject Date Issued Bulletin Number Ch. 1163
1221Medical Assistance Program Fee Schedule Procedure Code Changes for Medical Rehabilitation Units of General Hospitals and Rehabilitation Hospitals 06/17/06 01-06-06 Ch. 1101
1150Medical Assistance Program Fee Schedule Procedure Code Changes 06/17/06 99-06-06 Ch. 1123 Medical Assistance Program Fee Schedule Revision for Oxygen and Oxygen Equipment 06/06/06 24-06-10
25-06-01Ch. 1241 Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine 06/01/06 01-06-04
08-06-10
09-06-10
31-06-15
33-06-03Ch. 1121 Medicaid Drug Rebate Program Participating Drug Labelers Updated List 05-05-06 08-06-09
09-06-09
24-06-09
31-06-14Ch. 1123 Ventilator Dependent Respiratory (VDR) Program Preparing Table of Supply and Equipment Costs 04/28/06 03-06-08 Ch. 1121 Preferred Drug List—Quarterly Update 04/24/06 02-06-07
11-06-06
30-06-06
03-06-07
14-06-08
31-06-13
08-06-08
24-06-08
32-06-05
09-06-07
27-06-10Ch. 1121 Prior Authorization of Revatio 04/24/06 02-06-06
11-06-05
30-06-05
03-06-06
14-06-07
31-06-12
08-06-07
24-06-07
32-06-05
09-06-07
27-06-10Ch. 1150 Prudent Payment of Claims 04/20/06 99-06-04 Ch. 1241 2006 Recommended Childhood and Adolescent Immunization Schedule 04/16/06 01-06-03
08-06-06
09-06-05
31-06-11
33-06-02— Continued Existence of the Fee-for-Service (FFS) Delivery System in HealthChoices Zones and Use of ACCESS Cards 04/14/06 99-06-05 Ch. 1149 Elimination of Post-Operative Review of Endodontic Therapy for Individuals 21 Years of Age and Older 03-21-06 27-06-09 Ch. 1121 Prior Authorization of Botox, Synagis and Xolair 03/09/06 02-06-05
03-06-04
08-06-05
09-06-04
11-06-04
14-06-06
24-06-05
27-06-08
30-06-03
31-06-08
32-06-03— Special Pharmaceutical Benefits Program Revisions to Payment Methodology 03/07/06 19-06-03
24-06-06
31-06-10Ch. 1121 Federal Clarification—Elimination of Medicaid Coverage of Drugs for Treatment of Erectile Dysfunction 03/07/06 03-06-03
02-06-04
08-06-04
09-06-13
11-06-03
14-06-05
24-06-04
27-06-07
30-06-03
31-06-08
32-06-03Ch. 1150 Corrections to MA Bulletin 99-05-15 Addition of 2005 HCPCS Codes to Medical Assistance Programs Fee Schedule' 03/01-06 99-06-02 Ch. 1127 Medical Assistance Program Fee Schedule Procedure Code Changes for Birth Centers 02/28/06 47-06-01 Ch. 1221 Medical Assistance Program Fee Schedule Procedure Code Changes for Independent Medical-Surgical Clinic Services 02/28/06 08-06-03 Ch. 1121 Pen and Ink Change—Preferred Drug List (PDL), Phase 4 02/20/06 27-06-06 Ch. 1130 Medical Assistance Program Fee Schedule Procedure Code Changes for Hospice Services 01/27/06 06-06-01
31-06-06Ch. 1150 Disenrollment of Dual Eligibles from Physical Health Managed Care 01/27/06 99-06-01 Ch. 1141 Medical Assistance Program Fee Schedule Procedure Code Changes for Physician Services 01/27/06 31-06-05 Ch. 1143 Medical Assistance Program Fee Schedule Procedure Code Changes for Podiatry Services 01/27/06 14-06-04 Ch. 1121 Prior Authorization of Drugs that Exceed Est. Quantity Limits—Phase 3 Enforcement and Additional Drugs With Quantity Limits 01/27/06 02-06-03
03-06-02
08-06-02
09-06-02
11-06-02
14-06-03
24-06-02
27-06-05
30-06-02
31-06-04
32-06-02Ch. 1142 Medical Assistance Program Fee Schedule Procedure Code Changes for Certified Nurse Midwife Services 01/27/06 33-06-01 Ch. 1144 Medical Assistance Program Fee Schedule Procedure Code Changes for Certified Registered Nurse Practitioner Services 01/27/06 09-06-03 Ch. 1121 Preferred Drug List—Phase 4 01/25/06 02-06-02
03-06-01
08-06-01
09-06-01
11-06-01
14-06-02
24-06-01
27-06-04
30-06-01
31-06-03
32-06-01Ch. 1221 Removal of Prior Authorization Requirement for Sleep Studies 01/12/06 01-06-02
31-06-02— Dental Behavior Management Fee Increase 01/03/06 27-06-01 Ch. 1149
1101
1150Medical Assistance Program Fee Schedule Changes for Orthodontic and Cleft Palate Services: Fee Increases, Procedure Code Changes and New Prior Authorization Requirements 01/03/06 27-06-03
17-06-01
19-06-01
20-06-01
21-06-01Ch. 1163 Place of Service Review Procedures 01/03/06 14-06-01
01-06-01
02-06-01
31-06-01
27-06-02Ch. 1150 Prudent Payment of Claims 04/03/06 99-06-04 2007 — ''Issuance of an Updated MA Program Outpatient Fee Schedule for Durable Medical Equipment, Medical Supplies, Orthotics, Prosthetics, Vision and Hearing Supplies'' included in MA Bulletin 05-05-04, et al titled ''Medical Assistance Program Fee Schedule Procedure'' 12/28/07 01-07-12
05-07-03
18-07-02
20-07-06
24-07-15
25-07-07
31-07-21— Medical Assistance Program Fee Schedule Revision 12/21/07 99-07-21 — Revision to Medical Assistance Program Fee Schedule for Federally Qualified Health Centers and Rural Health Clinics 12/21/07 08-07-16 Ch. 1150 The Addition of Isentress (raltegravir) to the Special Pharmaceutical Benefits Program 12/21/07 09-07-16
21-07-04
24-07-16
31-07-22— Nursing Facility Documentation Requirements for Movable Equipment That is Rented or Leased 12/07/07 03-07-10 — Error Reconciliation Recommendations for the National Provider Identifier (NPI) 12/01/07 99-07-20 Ch. 1123 MA Program Outpatient Fee Schedule Revisions for Speech Generating Devices 11/29/07 24-07-11
25-07-05
31-07-18Ch. 1121 Preferred Drug List—Fall Update—Part 2 11/29/07 02-07-06
11-07-07
30-07-07
03-07-09
14-07-06
31-07-20
08-07-15
24-07-14
32-07-07
09-07-14
27-07-09Ch. 1149 Fee Increase for Select Dental Procedure Codes 11/01/07 27-07-08 Ch. 1101 Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 11/01/07 99-07-19 Ch. 1121 Preferred Drug List—Fall 2007 Update 11/01/07 02-07-05
11-07-06
30-07-05
03-07-08
14-07-05
31-07-17
08-07-14
24-07-13
32-07-06
09-07-12
27-07-07Ch. 1141 Fee Increases for Select Office Visit and Office Consultation Procedure Codes 11/01/07 09-07-13
31-07-16
33-07-04Ch. 1121 Delay in Implementation of the Tamper—Resistant Pad Requirements 10/29/07 99-07-18 Ch. 1121 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling for HIV Applicants 10/15/07 09-07-10
21-07-03
24-07-10
31-07-14Ch. 1121 Tamper Resistant Prescription Pads 09/28/07 99-07-16 Ch. 1123 2007 Power Mobility Device HCPCS Updates; Prior Authorization Requirements 09/19/07 99-07-15 — Peer Review Committee 09/14/07 99-07-14 Ch. 1145 Change in Recipient Access to Chiropractic Services 09/14/07 15-07-01 Ch. 1241 Correction of Billing Instructions for Physical and Occupational Therapy Evaluations, and Evaluations of Speech, Language, Voice, Communication and/or Auditory Processing 09/14/07 01-07-09
08-07-13
17-07-01
20-07-04
31-07-13— Updated Regarding False Claims Provisions of Deficit Reduction Act of 2005—Employee Education About False Claims Recovery 09/07/07 99-07-13 Ch. 1163 Medicare Inpatient Pricing Logic Modification 08/17/07 01-07-08 Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser Requirement and Updated Medical Assistance Program Fee Schedule for Hearing Aid Supplies 08/03/07 01-07-07
24-07-09
31-07-12
20-07-03
25-07-04— Clarification of Act 169, also known as the Older Adult Protective Services Act (OAPSA), in regard to hiring Practices for inpatient and residential facilities 08/02/07 OMHSAS-07-01 Ch. 1121 Preferred Drug List—May 2007 Technical Correction 07/31/07 02-07-04
11-07-05
30-07-04
03-07-07
14-07-04
31-07-11
08-07-12
24-07-08
32-07-05
09-07-09
27-07-06Ch. 1121 Preferred Drug List—Updates to Prior Authorization of Pharmaceutical Services Handbook Pages 07/27/07 02-07-03
11-07-04
30-07-03
03-07-06
14-07-03
31-07-10
08-07-11
24-07-07
32-07-04
09-07-08
27-07-05Ch. 1149 Discontinuance of the Prior Authorization Requirement for Dental Procedure Codes D7140 and D7210 07/11/07 27-07-04 Ch. 1249 Rescission of the Statement of Policy Clarifying the Conditions Under Which Medical Assistance Recipients May Be Considered Homebound 07/10/07 1249-07-04
99-07-12Ch. 1123 Special Pharmaceutical Benefits Program (SPBP) Income Ceiling Increase for HIV Applicants 07/01/07 09-07-05
21-07-02
24-07-04
31-07-07— Revised MA Bulletin 03-07-01: Billing Instructions—Medicare Non-Coverage for Medicare Eligible Nursing Facility Residents 06/29/07 03-07-05 Ch. 1101 The Elimination of Paper Vouchers 06/14/07 99-07-10 — Revised Citizenship and Identify Information Form 06/08/07 99-07-09 Ch. 1123 Requirements for Coverage of Enteral Nutritional Supplements and Issuance of Enteral Nutritional Supplements MA Program Outpatient Fee Schedule 06/01/07 08-07-10
09-07-07
24-07-06
25-07-03
31-07-09Ch. 1121 Preferred Drug List—July 2007 Quarterly Update 06/01/07 02-07-02
03-07-03
08-07-08
09-07-06
11-07-02
14-07-02
24-07-05
27-07-03
30-07-02
31-07-08
32-07-03Ch. 1101 Co-pay/Deductibles on Exceptional Durable Medical Equipment (DME) 06/01/07 03-07-04 — Responsibility of MA Providers to Provide Requested Medical/Psychological Information to the Disability Advocacy Program (DAP) 05/18/07 99-07-08 — Instructions for Using Your National Provider Identifier (NPI) Number to Bill the Department of Public Welfare (DPW) and Contingency Plan 05/18/07 99-07-07 Ch. 1150 Medical Assistance Program Fee Schedule Revision; Change to Conversion Factor for Anesthesia Services 05/10/07 31-07-05
32-07-0001Ch. 1243 Medical Assistance Program Fee Schedule Revision of Two Laboratory Procedure Codes 05/03/07 01-07-04
08-07-02
28-07-01Ch. 1121 Preferred Drug List—Quarterly Update 05/01/07 02-07-01
03-07-02
08-07-07
09-07-04
11-07-01
14-07-01
24-07-03
27-07-02
30-07-01
31-07-06
32-07-02Ch. 1101 Clarification Regarding the Definition of Medically Necessary—Statement of Policy 04/21/07 99-07-04
1101-07-03Ch. 1221 Pen and Ink Change—Medical Assistance Bulletin 'Medical Assistance Program Fee Schedule Procedure Code Changes For Family Planning Clinic Services' 03/30/07 08-07-06
08-05-09Ch. 1241 2007 Recommended Childhood and Adolescent Immunization Schedules 03/23/07 01-07-05
08-07-04
09-07-02
31-07-03
33-07-01Ch. 1149 Discontinuance of the Dental Services Handbook 03/23/07 27-07-1 Ch. 1241 Gardasil®, Human Papillomavirus (HPV) Vaccine 03/23/07 01-07-02
08-07-05
09-07-03
31-07-04
33-07-02Ch. 1129 Revision to Medical Assistance Program Local to National Provider Code Crosswalk for Federally Qualified Health Centers and Rural Health Clinics 03/23/07 08-07-03 Ch. 1123 Medical Assistance Program Fee Schedule Procedure Code Changes For Hearing Aid Supplies 03/01/07 01-07-02
20-07-01
31-07-01Ch. 1123 Provider Specialty 220 (Hearing Aid Dispenser) Requirement 03/01/07 01-07-03
20-07-02
24-07-01
25-07-01
31-07-02Ch. 1245 Clarification of Procedure Codes and Modifiers to be Used When Billing For Ambulance Services 02/20/07 26-07-01 — Replace MA Bulletin 03-06-12: Billing Instructions—Medicare Non-Coverage For Medicare Eligible Nursing Facility Residents 02/20/07 03-07-01 Ch. 1221 Correction to Title XIX Medical Assistance Program Family Planning Clinic Fee Schedule 02/06/07 08-07-01 Ch. 1123 Behavioral Health Fee For Service (BH-FFS) Transfer from Office of Medical Assistance Programs (OMAP) To Office of Mental Health and Substance Abuse Services (OMHSAS) 01/31/07 OMHSAS-06-07 — Revised Medical Assessment Form (PA 635) 01/12/07 01-07-01
19-07-01
09-07-01Ch. 1150 Policy Reinforcement Regarding Billing For Tobacco Cessation Counseling Services 01/04/07 99-07-02 — False Act Claims Provisions of Deficit Reduction Act of 2005 Employee Education About False Claims Recovery 01/02/07 99-07-01 2008 Ch. 1121 Preferred Drug List—Fall 2007 Update Part 2 Technical Correction 01/11/08 02-07-08
03-07-11
08-07-17
09-07-17
11-07-08
14-07-07
24-07-17
27-07-10
30-07-08
31-07-23
32-07-08Ch. 1149 Implementation of ADA Claim Form—Version 2006 and Elimination of Dental Prior Authorization Forms 01/11/08 17-08-01
19-08-01
20-08-01
21-08-01
27-08-01Ch. 1163 Preventable Serious Adverse Events 01/14/08 01-07-11 Ch. 1121 Legend Attachment to Medical Assistance Bulletin 01-07-12, et al 01/31/2008 01-08-01
05-08-01
18-08-01
20-08-01
24-08-01
25-08-01
31-08-01Ch. 1101 Implementation of SelectPlan for Women 02/01/08 01-08-02
08-08-02
09-08-02
24-08-03
28-08-01
31-08-03
33-08-01Ch. 1241 Clarification of Childhood Nutrition and Weight Management Services for Recipients Under 21 Years of Age 02/15/08 99-08-01 Ch. 1241 The Addition of Selzentry (maraviroc) and Intelence (etavirine) to the Special Pharmaceutical Benefits Program 02/29/08 09-08-03
24-08-04
21-08-01
31-08-04Ch. 1121 Medical Necessity Guidelines for Lyrica for Fibromyalgia 03/05/08 02-08-01
03-08-01
08-08-01
09-08-01
11-08-01
14-08-01
24-08-02
27-08-02
30-08-01
31-08-02
32-08-01Ch. 1141 Medical Assistance Program Outpatient Fee Schedule Changes for Select Chemotherapy Administration Procedure Codes 03/14/08 01-08-03
08-08-03
31-08-05Ch. 1101
1150MA Program Fee Schedule Changes—2007 HCPCS Updates; Addition of Procedure Codes and Modifiers; Prior Authorization 03/14/08 99-08-04 Ch. 1141
1126Medical Assistance Program Outpatient Fee Schedule Changes for Select Office Visit Procedure Codes 03/14/08 31-08-06
09-08-04
33-08-02Ch. 1121 Tamper Resistant Prescription Pads 03/21/08 99-08-03 Ch. 1241 2008 Recommended Childhood and Adolescent Immunization Schedules 3/21/08 01-08-04
08-08-04
09-08-05
31-08-07
33-08-07Ch. 1101 SelectPlan for Women Program—Addition of Covered Services 04/23/08 01-08-05
08-08-06
09-08-07
24-08-06
28-08-03
31-08-09
33-08-04Ch. 1150 Prudent Payment of Claims—Updated 04/25/08 99-08-05 Ch. 1121 Preferred Drug List—Spring 2008 Update 06/02/08 02-08-03
03-08-03
08-08-07
09-08-08
11-08-03
14-08-03
24-08-07
27-08-04
30-08-03
31-08-10
32-08-03— Revised Error Reconciliation Recommendations for the National Provider Index (NPI) 06/05/08 99-08-07 Ch. 1149 ADA Claim Form—Version 2006 and Discontinuance of P.O. Box 8186 06/16/08 17-08-02 Ch. 1123 Nursing Facility Documentation Requirements for Moveable Equipment That is Rented or Leased 07/07/08 03-08-04 Ch. 1101 Fee-For-Service Coverage for Recipients In Health Care Benefits Package 12 07/16/08 99-08-09 Ch. 1121 Prior Authorization of Early Refills of Prescriptions 07/18/08 02-08-04
11-08-04
30-08-08
03-08-08
08-08-11
09-08-12
14-08-04
24-08-08
27-08-07
31-08-15
32-08-04Ch. 1150
Ch. 1141
Ch. 1147Medical Assistance Program Fee
Increase for Select Ophthalmological
Examinations07/22/08 18-08-04
31-08-12Ch. 1150
Ch. 1249Medical Assistance (MA) Program Fee
Increases for Select Home Health Agency Services07/22/08 05-08-02 Ch. 1150
Ch. 1141
Ch. 1147Medical Assistance Program Fee
Increases for Select Office Visits and
Consultations for Vision Services07/22/08 18-08-03 Ch. 1150
Ch. 1249Medical Assistance Program Fee
Increases for Select Private Duty/Shift Nursing Services to MA Recipients Under 21 Years of Age07/22/08 05-08-03
16-08-01Ch. 1150
Ch. 1149Medical Assistance Program Fee
Increases for Select Dental Services07/22/08 27-08-06 Ch. 1150 Medical Assistance Program Fee
Increases for Select Office Visits and Consultations07/22/08 09-08-09
31-08-11
33-08-05Ch. 1150
Ch. 1243Medical Assistance Program Fee
Schedule Changes for Select Laboratory Procedure Codes07/22/08 08-08-09
09-08-10
28-08-04
31-08-13
33-08-06Ch. 1150
Ch. 1141Medical Assistance Program Outpatient
Fee Schedule Increase for a Select Colonoscopy Procedure07/22/08 01-08-07 Ch. 1150 Fee Increases for Select Healthy Beginnings Plus Services 07/25/08 05-08-04
08-08-13
31-08-17
33-08-08
47-08-11Ch. 1150
Ch. 1241Screening for Developmental Delays
and Autism Spectrum Disorders07/25/08 99-08-10 Ch. 1145 Recipient Access to Chiropractic Services 08/04/08 99-08-11 Ch. 1150 Prior Authorization of Advanced Radiologic Imaging Services 08/05/08 99-08-08 Ch. 1121 Prior Authorization of Tysabri 08/25/08 02-08-07
11-08-07
30-08-07
03-08-07
14-08-06
31-08-20
08-08-16
24-08-11
32-08-08
09-08-16Ch. 1121 Prior Authorization of Letaris, Methadone, and Myobloc 08/25/08 02-08-05
11-08-05
30-08-05
03-08-05
14-08-05
31-08-18
08-08-14
24-08-09
32-08-06
09-08-14
27-08-08Ch. 1121 Prior Authorization of Atypical Antipsychotics, Cough and Cold Medications, and Stimulants and Related Agents 08/25/08 02-08-06
11-08-06
30-08-06
03-08-06
14-08-06
31-08-19
08-08-15
24-08-10
32-08-07
09-08-15
27-08-09Ch. 1150
Ch. 1225Medical Assistance Program Family
Planning Clinic Select Fee Increases and Updates08/29/08 08-08-08 Ch. 1101
Ch. 1150
Ch. 1221SelectPlan for Women Updated
Covered Services Chart09/05/08 01-08-09
08-08-17
09-08-17
24-08-12
28-08-06
31-08-21
33-08-09Ch. 1121 Prior Authorization of Erythropoiesis Stimulating Proteins 09/10/08 02-08-08
11-08-08
30-08-08
03-08-09
14-08-08
31-08-22
08-08-18
24-08-13
32-08-10
09-08-18
27-08-11Ch. 1163 Payment Policy for Hospital Readmissions 09/12/08 01-08-10 Ch. 1241 Updates for Early Periodic Screening, Diagnosis and Treatment Program 09/18/08 99-08-13 Ch. 1150
Ch. 1121Reminder of Implementation of Tamper
Resistant Prescription Pad Requirements09/24/08 99-08-14 Ch. 1121 Synagis—Updated Guidelines to Determine Medical Necessity 10/10/08 02-08-10
11-08-10
30-08-10
03-08-11
14-08-10
31-08-24
08-08-20
24-08-15
32-08-12
09-08-20
27-08-13Ch. 1121 Cytokine and CAM Antagonists—Updated Guidelines to Determine Medical Necessity 10/10/08 02-08-09
11-08-09
30-08-09
03-08-10
14-08-09
31-08-23
08-08-19
24-08-14
32-08-11
09-08-19
27-08-12Ch. 1141
1163Increase to Maximum Medical Assistance Payment to Practitioners for Services Provided During a Period of Hospitalization 10/20/08 09-08-16 Ch. 1101
1150Implementation of Claim Check 10/20/08 99-08-17 — Specialty Pharmacy Drug Program 10/20/08 99-09-01 Ch. 1121 Non-Payment of Antidementia Drugs for Children Less Than 18 Years of Age 10-20-08 99-08-15 Ch. 1121 Preferred Drug List 2008 Update 10/31/08 02-08-11
03-08-12
08-08-21
09-08-21
11-08-11
14-08-11
24-08-16
27-08-14
30-08-11
31-08-25
32-08-13Ch. 1101
Ch. 1150Implementation of Claim Check 10/02/08 99-08-17 Ch. 1121 Grandfathering of Prescriptions for Non-Preferred Atypical Antipsychotics for Children Under Six (6) Years of Age 11/07/08 02-08-12
11-08-12
30-08-12
03-08-13
14-08-12
31-08-26
08-08-22
24-08-17
32-08-14
09-08-22
27-08-15Ch. 1150
Ch. 1147Addition of Procedure Code 67820 to
Optometrist Medical Assistance Program Outpatient Fee Schedule11/14/08 18-08-07 Ch. 1150 Preventable Serious Adverse Events 11/26/08 01-08-11 — Special Pharmaceutical Benefits Program (SPBP)—Updated Eligibility Criteria for SP1 Card Holders 12/05/08 08-08-23
09-08-23
24-08-18
01-08-04
31-08-27Ch. 1150
Ch. 1147Addition of Procedure Codes to the
Medical Assistance Program Fee Schedule for Office Visits for Optometrists12/29/08 18-09-01 2009 Ch. 1150
Ch. 1123
Ch. 1147Removal of Prior Authorization
Requirement for Eyeglass Lenses02/09/09 18-09-02
24-09-01
25-09-01
31-09-01Ch. 1101
Ch. 1150
Ch. 1241Pentacel® (DTaP-IPV/Hib), Kinrix®
(DTaP-IPV) and Rotarix® (Rotavirus)
Vaccines02/09/09 01-09-01
08-09-01
09-09-01
31-09-02
33-09-01— Special Pharmaceutical Benefits Program (SPBP)—2009 Federal Poverty Guidelines for SP1 Card Holders 02/13/09 01-09-03
24-09-03
08-09-03
28-09-02
09-09-03
31-09-04
21-09-02Ch. 1101
Ch. 1150
Ch. 12412009 Recommended Childhood and
Adolescent Immunization Schedules02/20/09 01-09-04
08-09-04
09-09-04
31-09-05
33-09-02— Clarifying Medical Assistance (MA) Policy related to Medicare Cost Sharing under Part D for Dual Eligible Recipients in the MA Program 03/10/09 99-09-02 — Clarification of Procedures for Responding to Requests for Copies of Medical Assistance (MA) Recipients' Bills 03/20/09 99-09-03 Ch. 1121 Prior Authorization of Hypoglycemics, Incretin Mimetics—Enhancers 03/20/09 02-09-01
11-09-01
30-09-01
03-09-01
14-09-01
31-09-06
08-09-05
24-09-04
32-09-01
09-09-05
27-09-01Ch. 1150 Medical Assistance Program Fee Schedule Procedure Code End-dating of Keratomileusis 03/27/09 99-09-04 Ch. 1149 Implementation of the Pediatric Dental Periodicity Schedule 04/24/09 27-09-02 Ch. 1121 Medical Necessity Guidelines for Cymbalta for Treatment of Fibromyalgia 05/22/09 01-09-05
02-09-02
03-09-02
08-09-06
09-09-06
11-09-02
14-09-02
24-09-05
27-09-03
30-09-02
31-09-07
32-09-02Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update 06/05/09 01-09-06
09-09-07
27-09-04
02-09-03
11-09-03
30-09-03
03-09-03
14-09-08
31-09-08
08-09-07
24-09-06
32-09-03Ch. 1150 Revisions to Medical Assistance Program Fee Schedule Rates for Select Services 06/15/09 99-09-05 Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Cytokine and CAM Antagonists Updated Handbook Pages 06/19/09 01-09-09
02-09-06
03-09-06
08-09-10
09-09-10
11-09-06
14-09-06
24-09-09
27-09-07
30-09-06
31-09-11
332-09-06Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Hypoglycemics, Insulins Updated Handbook Pages 06/19/09 01-09-07
02-09-04
03-09-04
08-09-08
09-09-08
11-09-04
14-09-04
24-09-07
27-09-05
30-09-04
31-09-09
32-09-04Ch. 1121 Automated Prior Authorization of Pharmacy Services—Stimulants and Related Agents Updated Handbook Pages 06/29/09 01-09-11
08-09-12
14-09-08
30-09-08
02-09-08
09-09-12
24-09-11
31-09-13
03-09-08
11-09-08
27-09-08
32-09-08Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Antibiotics, GI Updated Handbook Pages 06/29/09 01-09-26
02-09-23
03-09-23
08-09-27
09-09-27
11-09-23
14-09-23
24-09-26
27-09-23
30-09-23
31-09-28
32-09-23Ch. 1121 Automated Prior Authorization of Pharmacy Services—Bronchodilators, Beta Agonist Updated Handbook Pages 06/29/09 01-09-25
02-09-22
03-09-22
08-09-26
09-09-26
11-09-22
14-09-22
24-09-25
27-09-22
30-09-22
31-09-27
32-09-22Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Inhaled Glucocorticoids Updated Handbook Pages 06/29/09 01-09-17
02-09-14
03-09-14
08-09-18
09-09-18
11-09-14
14-09-14
24-09-17
27-09-14
30-09-14
31-09-19
32-09-14Ch. 1121 Automated Prior Authorization of Pharmacy Services—Sedative Hypnotics Updated Handbook Pages 06/29/09 01-09-12
08-09-13
14-09-09
30-09-09
02-09-09
09-09-13
24-09-12
31-09-14
03-09-09
11-09-09
27-09-09
32-09-09Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Oral Antifungals Updated Handbook Pages 06/29/09 01-09-16
02-09-13
03-09-13
08-09-17
09-09-17
11-09-13
14-09-13
24-09-16
27-09-13
30-09-13
31-09-18
32-09-13Ch. 1121 Automated Prior Authorization of Pharmacy Services—Minimally Sedating Antihistamines Updated Handbook Pages 06/29/09 01-09-23
02-09-20
03-09-20
08-09-24
09-09-24
11-09-20
14-09-20
24-09-23
27-09-20
30-09-20
31-09-25
32-09-20Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Pulmonary Arterial Hypertension (PAH) Agents Handbook Pages 06/29/09 01-09-13
08-09-14
14-09-10
30-09-10
02-09-10
09-09-14
24-09-13
31-09-15
03-09-10
11-09-10
27-09-10
32-09-10Ch. 1121 Automated Prior Authorization of Pharmacy Services—Ophthalmic Immunomodulators Updated Handbook Pages 06/29/09 01-09-14
08-09-15
14-09-11
30-09-11
02-09-11
09-09-15
24-09-14
31-09-16
03-09-11
11-09-11
27-09-11
32-09-11Ch. 1121 Automated Prior Authorization of Pharmacy Services—Antidepressants, SSRIs Updated Handbook Pages 06/29/09 01-09-22
02-09-19
03-09-19
08-09-23
09-09-23
11-09-19
14-09-19
24-09-22
27-09-19
30-09-19
31-09-24
32-09-19Ch. 1121 Automated Prior Authorization of Pharmacy Services—Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) 06/29/09 01-09-24
02-09-21 03-09-21
08-09-25
09-09-25
11-09-21
14-09-21
24-09-24
27-09-21
30-09-21
31-09-26
32-09-21Ch. 1121 Pharmacy Update—Oral Fluoroquinolones Updated Handbook Pages 06/29/09 01-09-20
02-09-17
03-09-17
08-09-21
09-09-21
11-09-17
14-09-17
24-09-20
27-09-17
30-09-17
31-09-22
32-09-17Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Intranasal Rhinitis Agents Updated Handbook Pages 06/29/09 01-09-18
02-09-15
03-09-15
08-09-19
09-09-19
11-09-15
14-09-15
24-09-18
27-09-15
30-09-15
31-09-20
32-09-15Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Growth Hormones Updated Handbook Pages 06/29/09 01-09-19
02-09-16
03-09-16
08-09-20
09-09-20
11-09-16
14-09-16
24-09-19
27-09-16
30-09-16
31-09-21
32-09-16Ch. 1121 Automated Prior Authorization of Pharmacy Services—Bronchodilators, Anticholinergic Updated Handbook Pages 06/29/09 01-09-21
02-09-18
03-09-18
08-09-22
09-09-22
11-09-18
14-09-18
24-09-21
27-09-18
30-09-18
31-09-23
32-09-18Ch. 1121 Spring 2009 Preferred Drug List (PDL) Pharmacy Update—Acne Agents, Oral Updated Handbook Pages 06/29/09 01-09-10
08-09-11
14-09-07
30-09-07
02-09-07
09-09-11
24-09-10
31-09-12
03-09-07
11-09-07
27-09-08
32-09-07Ch. 1121 Automated Prior Authorization of Pharmacy Services—Lipotropics, Statins Updated Handbook Pages 06/29/09 01-09-15
02-09-12
03-09-12
08-09-16
09-09-16
11-09-12
14-09-12
24-09-15
27-09-12
30-09-12
31-09-17
32-09-12Ch. 1150 2008 HCPCS Updates and Other Procedure Code and Procedure Code/Modifier Combination Changes 07/06/09 99-09-06 Ch. 1121 Prior Authorization of Benzodiazepines—Pharmacy Services 07/27/09 01-09-31
02-09-28
03-09-28
08-09-32
09-09-32
11-09-28
14-09-28
24-09-31
27-09-29
30-09-28
31-09-33
32-09-28Ch. 1121 Prior Authorization of Buprenorphine Agents (Suboxone and Subutex)—Pharmacy Services 07/27/09 01-09-30
02-09-27
03-09-27
08-09-31
09-09-31
11-09-27
14-09-27
24-09-30
27-09-28
30-09-27
31-09-32
32-09-27Ch. 1121 Prior Authorization of Topical Acne Agents—Pharmacy Services 07/27/09 01-09-28
02-09-25
03-09-25
08-09-29
09-09-29
11-09-25
14-09-25
24-09-28
27-09-26
30-09-29
31-09-30
32-09-25Ch. 1121 State Maximum Allowable Cost (MAC) List (Including the Federal Upper Limit)—Pharmacy Services 07/27/09 01-09-32
02-09-29
03-09-29
08-09-33
09-09-33
11-09-29
14-09-29
24-09-32
27-09-30
30-09-29
31-09-34
32-09-29Ch. 1121 Prior Authorization of Cough and Cold Medications for Children Under Six (6) years of Age—Pharmacy Services 07/27/09 01-09-27
02-09-24
03-09-24
08-09-28
09-09-28
11-09-24
14-09-24
24-09-27
27-09-25
30-09-04
31-09-29
32-09-24— Special Pharmaceutical Benefits Program (SPBP)—Addition of CD4 Tests to the List of Outpatient Laboratory Services for SP1 Card Holders 08/03/09 01-09-33
08-09-34
09-09-35
21-09-03
24-09-33
28-09-03
31-09-36Ch. 1105
Ch. 1150Revised Medical Assessment Form
(PA 635)8/10/09 31-09-38
19-09-01
09-09-34Ch. 1121 Prior Authorization of Skeletal Muscle Relaxants—Pharmacy Services 08/10/09 01-09-35
09-09-37
27-09-32
02-09-31
11-09-31
30-09-31
03-09-31
14-09-31
31-09-38
08-09-36
24-09-35
32-09-31Ch. 1121 Prior Authorization of Narcotic Analgesics—Pharmacy Services 08/10-09 01-09-34
09-09-36
27-09-31
02-09-30
11-09-30
30-09-30
03-09-30
14-09-30
31-09-37
08-09-35
24-09-34
32-09-30Ch. 1101
Ch. 1150Changes to Procedure Codes for the
Administration Fees for Kinrix® (DTaP-IPV) and Rotarix® (Rotavirus Vaccines08/13/09 01-09-38
08-09-39
09-09-40
31-09-41
33-09-03Ch. 1101
Ch. 1150
Ch. 1141
Ch. 1221SelectPlan for Women Program
Forumulary09/01/09 01-09-39
08-09-40
09-09-41
24-09-38
28-09-04
31-09-42
33-09-04Ch. 1121 SUBJECT Prior Authorization of Atypical Antipsychotics—Pharmacy Services 09/01/09 01-09-36
09-09-38
27-09-33
02-09-32
11-09-32
30-09-32
03-09-32
14-09-32
31-09-39
08-09-37
24-09-36
32-09-32Ch. 1101
Ch. 1150
Ch. 1141
Ch. 1221SelectPlan for Women Program—
Addition of Covered Services09/08/09 01-09-40
08-09-41
09-09-42
24-09-39
28-09-05
31-09-43
33-09-05Ch. 1150
Ch. 1241
Ch. 1121Structured Screening for Developmental
Delays and Autism Spectrum Disorders
Prior Authorization of Neulasta—Pharmacy Services09/08/09
09/17/0999-09-07
01-09-29
02-09-26
03-09-26
08-09-30
09-09-30
11-09-26
14-09-26
24-09-29
27-09-27
30-09-26
31-09-31
32-09-26Ch. 1121 Prior Authorization of Conventional (Typical) Antipsychotics—Pharmacy Services 09/21/09 01-09-37
09-09-39
27-09-34
02-09-33
11-09-33
30-09-33
03-09-33
14-09-33
31-09-40
08-09-38
24-09-37
32-09-33Ch. 1121 Available Resources: 2009 Novel Influenza Virus A (H1N1) 09/24/09 01-09-41
08-09-42
09-09-43
31-09-44
33-09-06Ch. 1141 Revisions to the Medical Assistance Program Fee Schedule Rates for Select Services 10/05/09 99-09-09 Ch. 1150 Billing for the Administration of the Influenza A (H1N1) 2009 Monovalent Vaccine 10-9-09 99-09-10 Ch. 1101
Ch. 1141
Ch. 1142
Ch. 1143
Ch. 1144
Ch. 1145
Ch. 1147
Ch. 1149Revision of the PROMISe® Individual
Practitioner Enrollment Application and Implementation of Credentialing for Certain
Providers Types10/16/09 99-09-08 Ch. 1121 Prior Authorization of Proton Pump Inhibitors (PPIs)—Pharmacy Services 10/20/09 01-09-42
08-09-43
14-09-34
30-09-34
02-09-34
09-09-44
24-09-40
31-09-45
03-09-34
11-09-34
27-09-35
32-09-34Ch. 1121 Fall 2009 Preferred Drug List (PDL) and Quantity Limits Update—Pharmacy Services 11/02/09 01-09-43
09-09-45
27-09-36
02-09-35
11-09-35
30-09-35
03-09-35
14-09-35
31-09-46
08-09-44
24-09-41
32-09-35Ch. 1141
Ch. 1145Recipient Access to Chiropractic
Services11/30/09 99-09-11 Ch. 1121 Steroids, Topical Low Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-51
09-09-53
27-09-44
02-09-43
11-09-43
30-09-43
03-09-43
14-09-43
31-09-54
08-09-52
24-09-49
32-09-43Ch. 1121 Ophthalmic Antibiotics Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-58
09-09-59
27-09-50
02-09-49
11-09-49
30-09-49
03-09-49
14-09-49
31-09-60
08-09-58
24-09-55
32-09-49Ch. 1121 Steroids, Topical High Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-54
09-09-55
27-09-46
02-09-45
11-09-45
30-09-45
03-09-45
14-09-45
31-09-56
08-09-54
24-09-51
32-09-45Ch. 1121 Platelet Aggregation Inhibitors Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-47
09-09-49
27-09-40
02-09-39
11-09-39
30-09-39
03-09-39
14-09-39
31-09-50
08-09-48
24-09-45
32-09-39Ch. 1121 Pharmacy Services Fall 2009 Preferred Drug List (PDL) Pharmacy Update—Bronchodilators, Beta Agonists Updated Handbook Pages 11/02/09 01-09-48
09-09-50
27-09-41
02-09-40
11-09-40
30-09-40
03-09-40
14-09-40
31-09-51
08-09-49
24-09-46
32-09-40Ch. 1121 Antivirals, Topical Updated Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-57
09-09-58
27-09-49
02-09-48
11-09-48
30-09-48
03-09-48
14-09-48
31-09-59
08-09-57
24-09-54
32-09-48Ch. 1121 Ophthalmic Anti-Inflammatories New Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-49
09-09-51
27-09-42
02-09-41
11-09-41
30-09-41
03-09-41
14-09-41
31-09-52
08-09-50
24-09-47
32-09-41Ch. 1121 Pancreatic Enzymes Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-50
09-09-52
27-09-43
02-09-42
11-09-42
30-09-42
03-09-42
14-09-42
31-09-53
08-09-51
24-09-48
32-09-42Ch. 1121 Steroids, Topical Very High Handbook Pages Pharmacy Services Fall 2009 Preferred Drug List (PDL) Update 11/02/09 01-09-55
09-09-56
27-09-47
02-09-46
11-09-46
30-09-46
03-09-46
14-09-46
31-09-57
08-09-55
24-09-52
32-09-46
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