Medicare, Medicaid, MCO Information
Code 90378 (Synagis) New Billing Process
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Better Health Care for All Floridians
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FLORIDA MEDICAID
A Division of the Agency for Health Care Administration
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Health Care Alerts & Provider Alerts Messages
January 2011
Provider Type(s): 25, 26, 29, 30, 66, 68, 77, 20
Code 90378 (Synagis) New Billing Process
Due to a CCI edit causing claims for code 90378 to reimburse only 1 unit, providers billing for Synagis should now use code J3490. This change in billing for Synagis will be retroactive to 10/1/2010. This change allows for reimbursement of all units given to recipients; after a medical reviewer determines medical necessity for each claim according to currently accepted criteria. Providers using code 90378 will continue to be reimbursed for only 1 unit.
Please see the Physician Services Coverage and Limitations Handbook for documentation and billing requirements for J3490.
LINKS
Florida Medicaid Web Portal | Florida Medicaid Health Information Network | Florida Medicaid HIPAA Information | HIPAA Transactions & Code Sets Standard | National Identifiers | Florida Medicaid EHR Incentive Program | FloridaHealthFinder.gov
QUESTIONS ABOUT FLORIDA MEDICAID?
Please direct questions about Medicaid policies to your local Medicaid area office. The Medicaid area offices' addresses and phone numbers are available on the Area Offices Web page.
ALERTS INFORMATION
The Florida Medicaid program has created an e-mail alert system to supplement the present method of receiving Provider Alerts information and to alert registered subscribers of "late-breaking" health care information. An e-mail will be delivered to your mailbox when Medicaid policy clarifications or other health care information is available that is appropriate for your selected area and provider type.
Visit the Florida Medicaid's Health Care Alerts page to subscribe now. You may unsubscribe or update your subscription at any time by clicking on "Manage your subscription" at the bottom of this e-mail. Other questions regarding the e-mail alert system can be sent to the Florida Medicaid Alerts Administrator.
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© 2010 Agency for Health Care Administration
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Medicare Extension Legislation Signed into Law
Late this afternoon, in a small ceremony in the Oval Office, President Obama signed into law H.R. 4994, the "Medicare and Medicaid Extenders Act of 2010," which stabilizes Medicare physician payments through the end of 2011. The legislation also includes funds to enable Medicare contractors to reprocess claims for physician services affected by provisions of the Patient Protection and Affordable Care Act with a retroactive effective date of January 1, 2010. AMA President Cecil Wilson, MD, and Board of Trustees Chair Ardis Hoven, MD, attended the ceremony, along with representatives of the AARP and the Military Officers Association of America, Senators John Barrasso, MD (R-WY) and Max Baucus (D-MT), and Representatives Pete Stark (D-CA), and Henry Waxman (D-CA).
In a statement made when this legislation cleared the Senate, President Obama noted: "It's time for a permanent solution that seniors and their doctors can depend on and I look forward to working with Congress to address this matter once and for all in the coming year."
The DCMA, FMA AND AMA are committed to working in the coming months to develop a long-term solution to the flawed Medicare physician payment formula that will achieve bipartisan support in Congress and by the Administration.
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