Billing & Coding

Code Added to Office Lab List

Effective Feb. 1, 2008, the following code was added to the office lab list.*

89322

Semen analysis; volume, count, motility and differential using strict morphologic criteria (e.g., Kruger)

A complete listing of office lab codes is available through the online provider manual at priorityhealth.com/provider/manual/billpymt/services/labs.

* Code may not apply to all physicians. See the “Office Lab Requirements” section in your contract for more information.

2008 CPT/HCPCS codes

The new 2008 vaccines listed below will not be covered, as they haven’t been approved by the FDA.

90650	Human Papillomavirus (HPV) vaccine, types 16 and 18, bivalent, three-dose schedule, for intramuscular use
90681	Rotavirus vaccine, human, attenuated, two-dose schedule, live for oral use
90661	Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90663	Influenza virus vaccine, pandemic formulation

We will continue to cover the approved vaccines as indicated in the online provider manual, located at priorityhealth.com/provider/manual/billpymt/services/vaccines.

Preferred Choice Claims

Preferred Choice members are not responsible for claims incurred prior to the Jan. 1, 2008, term date. Please note, we will be doing a runout of claims until July 31, 2008. Claims will be priced and sent to the Third-party Administrators (TPAs) that administer the claims.

Care Choices Medical Policy Changes

As former Care Choices members are being transitioned to Priority Health, it has become necessary to modify the Care Choices Medical Policies. These changes will be effective March 1, 2008. Below is a brief summary of the more major changes, which may impact your practice.

Code	Medical Service	Change
96116	Neuropsychological testing	Covered benefit, but now requires prior authorization
S8085 and G0235	Pet Scans	Specific codes are not a covered Benefit
0048T and 0049T	Artificial Heart, VAD	Specific codes are not a covered Benefit

Medicaid ID Number Update

Medicaid has changed from a 9-digit ID number to a 10-digit ID number. To accommodate these new numbers, Priority Health’s systems were upgraded in early March.

Until that time, here’s what to do:
For new  Priority Health Medicaid member records:

• You’ll see a temporary 9-digit number (beginning in 947) for these members on paper remittance advices (RAs).
  
• DO NOT UPDATE YOUR RECORDS with this 947 number.
  
• DO NOT SUBMIT CLAIMS USING THIS TEMPORARY NUMBER. They will be rejected. Use the new 10-digit number.
  
• All electronic RAs will show the new 10-digit number assigned by Medicaid.
• ID cards and member-related letters will show the new 10-digit number.
  
• On March 10, 2008, all Priority Health communications, including paper RAs, will show the new 10-digit number.

For current  Priority Health Medicaid member records:

• You will see the current 8-digit number on paper RAs from Priority Health until March 10, 2008. 
  
• You can update your records now and use the new 10-digit number, formed by adding two leading zeros to the current 8-digit number, on all claims you submit beginning Monday, Jan. 21, 2008.