Louisiana Medicaid: Policy updates from the Louisiana Department of Health – UHCprovider.com

We’re sharing policy updates from the Louisiana Department of Health (LDH) regarding:

• COVID-19 monoclonal treatment
• Cardiovascular services
• Cochlear implants

These updates apply to UnitedHealthcare Community Plan members in Louisiana. 

COVID-19 monoclonal treatment policy
LDH Informational Bulletin 22-14 announced the approval of an alternative payment methodology to all Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to receive reimbursement for COVID-19 monoclonal treatment when a member’s visit does not constitute a true encounter. This covers services starting Sept. 1, 2021, and throughout the COVID-19 federal public health emergency declaration.

Sample claim scenarios:

• A COVID-19 treatment code and corresponding administrative code billed with T1015 pays the COVID-19 administration code only
• A COVID-19 treatment code, corresponding administrative code and an evaluation and management (E&M) code billed with T1015 pays the T1015 encounter rate only
• If the in-home administration code M0201 is included in either of the above situations, M0201 should pay in addition to the other payments

You may begin submitting claims for dates of service on or after Sept. 1, 2021. We will automatically recycle claims previously denied due to non-coverage of the treatment and administration, assuming the claim meets the requirements in the first “sample claim scenarios” bullet listed above.

For information about submitting a corrected claim, visit UHCprovider.com/claims > Submit a Corrected Claim, Claim Reconsideration and Projects/Begin Appeal Process.

Cardiovascular services policy
LDH Informational Bulletin 21-30 announced an updated policy for cardiovascular services, effective Jan. 29, 2022. The policy covers invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) as treatment for cardiovascular conditions when certain criteria is met. The procedure is not covered for the following members:

• Members younger than 18
• Pregnant members
• Cardiac transplant members
• Solid organ transplant candidates
• Survivors of sudden cardiac arrest

Please note this policy when treating members and filing claims. Visit UHCprovider.com/claims for more information about our claims process. 

Cochlear implants policy
LDH Informational Bulletin 21-29 announced an updated policy for cochlear implant services (CPT® code 69930), effective Jan. 29, 2022. This service covers unilateral and bilateral cochlear implants when deemed medically necessary for the treatment of severe-to-profound, bilateral sensorineural hearing loss in members younger than 21.

All implants must be used in accordance with Food and Drug Administration (FDA) guidelines. Eligibility should be determined by a multidisciplinary care team that consists of – at a minimum – a fellowship-trained pediatric otolaryngologist or fellowship-trained otologist, an audiologist and a speech-language pathologist. Once it’s determined a member is eligible for cochlear implants, the implant surgery as well as postoperative aural rehabilitation by an audiologist and subsequent speech, language and hearing therapy will be covered. The cochlear implant post-operative programing and diagnostic analysis services will also be covered.

Questions?
Call UnitedHealthcare Community Plan of Louisiana Provider Services at 866-675-1607.

CPT® is a registered trademark of the American Medical Association.

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