A9575 Fee Schedule Update - NDC/HCPC Code Updates - CARC & RARC Update - Rate Update for Drug Codes

Maine Department of Health & Human Services sent this bulletin at 01/21/2020 05:45 AM EST

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A9575 Fee Schedule Update, CR 91945

Effective October 1, 2019, the rate for A9575 has been updated to $0.19 per unit on the MaineCare fee schedule due to a Centers for Medicare and Medicaid (CMS) rate update. Affected claims will be reprocessed. No provider action is needed.

NDC/HCPC Code Updates

The NDC/HCPC code combinations listed in the table below have been added to the Health PAS Online Portal. If you experienced claim denials when submitting the NDC/HCPC code combination listed, you may resubmit them now.

HCPC	NDC	Combination Effective Date
Q2009	00069547101	11/01/2019
J1956	00143972001	07/01/2012
J2060	00641604401	02/01/2019
J2543	00781311390	07/01/2019
Q9968	00517037405	02/01/2019
J9263	71288010120	06/01/2019
J3490	00338004941	11/01/2019
J3370	47781059707	05/29/2019
J3370	70004092459	07/01/2019
J7042	00409792609	05/16/2016
J3480	00409790209	10/01/2019
J3480	00409790203	10/01/2019
J3030	55150017301	11/01/2019
J3490	00013111420	11/01/2019
Q2009	00069547101	07/01/2019
J3370	47781059707	01/01/2019

Common Adjustment Reason Codes (CARC) & Remittance Advice Remark Codes (RARC) Update

The CARC and RARC reference document has been updated and is available by going to the Supplemental Billing Info folder on the Health PAS Online Portal. This information is useful for providers who have a difficult time understanding why their claims have denied.

This document is updated regularly with the most recent changes to CARC/RARC codes and is used as a crosswalk between the edit rules that can be viewed on a claim in the Health PAS Online Portal and the mapped CARC and RARC codes. These codes must follow HIPAA EDI standard codes for a Remittance Advice or 835 and adhere to the CAQH CORE III rules. A complete listing of CARC/RARC codes can be found on Washington Publishing Company’s website http://www.wpc-edi.com/.

Rate Update for Drug Codes, CR 90350

Effective October 1, 2019, the rates for certain drug codes have been updated on the MaineCare fee schedule due to a Centers for Medicare and Medicaid (CMS) rate update. Please see the table below. Affected claims will be reprocessed. No provider action is needed.

Procedure Code	Rate $	Procedure Code	Rate $	Procedure Code	Rate $	Procedure Code	Rate $	Procedure Code	Rate $
90371	$110.67	J1190	$194.34	J2560	$42.04	J7517	$0.54	J9351	$0.87
90375	$280.64	J1200	$0.91	J2597	$12.14	J7518	$3.34	J9352	$312.91
90376	$271.37	J1205	$49.65	J2680	$10.95	J7520	$5.95	J9354	$31.36
90396	$1,716.18	J1212	$586.51	J2690	$77.49	J7605	$10.38	J9355	$106.62
90585	$141.06	J1230	$16.54	J2700	$1.37	J7606	$12.17	J9357	$1,438.59
90586	$141.06	J1240	$6.73	J2704	$0.11	J7608	$5.81	J9360	$3.80
90632	$58.91	J1245	$0.08	J2720	$1.09	J7611	$0.19	J9370	$4.81
90634	$28.90	J1250	$6.99	J2724	$15.10	J7612	$0.27	J9371	$3,080.04
90675	$297.59	J1270	$0.32	J2760	$377.57	J7614	$0.06	J9390	$11.66
90691	$90.58	J1290	$493.74	J2765	$1.54	J7626	$2.16	J9395	$94.87
90714	$24.26	J1322	$241.45	J2778	$352.17	J7631	$4.75	J9400	$8.37
90715	$32.86	J1325	$16.19	J2780	$4.10	J7639	$47.79	Q0162	$0.02
A9576	$1.42	J1327	$4.29	J2785	$59.22	J7682	$36.79	Q2050	$355.07
A9578	$1.94	J1335	$43.47	J2788	$24.92	J8501	$4.31	Q4081	$1.10
A9579	$1.59	J1364	$75.76	J2790	$79.56	J8510	$24.18	Q4101	$30.71
A9585	$0.35	J1380	$10.75	J2792	$29.78	J8520	$1.36	Q4106	$33.00
J0129	$54.32	J1410	$308.93	J2800	$9.06	J8521	$3.48	Q4121	$41.07
J0132	$1.04	J1439	$1.10	J2805	$109.97	J8530	$3.31	Q4132	$117.92
J0171	$0.83	J1442	$0.96	J2820	$43.44	J8560	$75.36	Q4133	$140.56
J0178	$952.47	J1447	$0.57	J2860	$103.06	J8610	$0.24	Q4186	$160.42
J0180	$183.43	J1450	$4.71	J2930	$6.12	J8655	$245.74	Q4195	$89.70
J0185	$2.17	J1451	$8.54	J2997	$87.64	J8705	$103.66	Q4196	$104.83
J0202	$1,917.04	J1453	$1.97	J3000	$31.53	J9000	$3.73	Q5105	$0.96
J0207	$1,003.59	J1459	$40.12	J3010	$0.89	J9015	$4,964.62	Q5106	$9.63
J0221	$171.05	J1460	$39.91	J3060	$40.08	J9017	$44.31	Q5108	$327.41
J0256	$4.55	J1559	$10.44	J3090	$1.49	J9022	$77.01	Q5110	$0.64
J0278	$1.11	J1560	$399.09	J3095	$5.74	J9023	$82.97	Q9950	$19.54
J0280	$10.88	J1561	$39.14	J3101	$121.83	J9025	$1.16	Q9956	$32.27
J0287	$6.18	J1566	$61.20	J3105	$1.63	J9027	$61.69	Q9957	$48.41
J0289	$26.09	J1568	$35.68	J3145	$1.47	J9032	$40.07	Q9966	$0.31
J0290	$1.00	J1569	$37.47	J3230	$31.61	J9033	$27.84	Q9967	$0.12
J0295	$2.06	J1570	$48.41	J3240	$1,695.12	J9034	$22.85	Q9968	$6.40
J0360	$4.21	J1571	$60.06	J3246	$6.92	J9035	$81.18	Q9991	$1,673.36
J0401	$5.70	J1572	$35.59	J3250	$36.79	J9039	$113.40	Q9992	$1,673.36
J0456	$3.05	J1573	$60.06	J3260	$3.60	J9040	$26.66
J0470	$55.29	J1575	$14.56	J3262	$4.96	J9041	$44.69
J0475	$169.51	J1580	$1.91	J3285	$63.85	J9042	$162.44
J0476	$50.05	J1602	$21.58	J3301	$1.57	J9043	$173.67
J0480	$3,799.93	J1610	$199.27	J3315	$258.74	J9047	$37.60
J0500	$57.58	J1626	$0.40	J3316	$2,897.33	J9050	$3,039.01
J0515	$17.74	J1627	$2.74	J3358	$12.04	J9055	$62.05
J0517	$168.50	J1630	$0.97	J3360	$11.09	J9060	$1.88
J0558	$10.89	J1631	$16.48	J3370	$3.46	J9065	$19.00
J0561	$13.82	J1640	$23.72	J3380	$19.86	J9070	$34.14
J0570	$1,303.53	J1642	$0.25	J3385	$345.52	J9098	$81.42
J0587	$11.99	J1644	$0.21	J3396	$11.08	J9100	$0.56
J0592	$4.56	J1645	$12.58	J3410	$6.59	J9120	$1,098.20
J0596	$28.22	J1650	$0.83	J3411	$1.91	J9130	$4.14
J0597	$51.31	J1652	$1.73	J3420	$1.89	J9145	$53.95
J0610	$2.70	J1670	$432.66	J3430	$4.28	J9150	$46.74
J0630	$2,661.05	J1720	$12.90	J3475	$0.85	J9155	$3.97
J0636	$0.61	J1740	$43.48	J3480	$0.14	J9171	$0.87
J0637	$6.85	J1742	$278.77	J3489	$12.47	J9173	$74.64
J0641	$0.40	J1745	$63.29	J7030	$2.42	J9176	$6.50
J0670	$2.45	J1786	$42.94	J7040	$1.21	J9178	$0.95
J0690	$0.77	J1800	$8.48	J7042	$0.91	J9179	$114.27
J0692	$1.91	J1815	$0.88	J7050	$0.60	J9181	$0.56
J0694	$5.23	J1817	$10.78	J7060	$1.85	J9185	$56.58
J0695	$5.60	J1830	$386.24	J7070	$3.63	J9190	$1.55
J0696	$0.54	J1885	$0.50	J7120	$2.32	J9200	$82.68
J0697	$2.03	J1930	$62.32	J7170	$47.35	J9201	$5.00
J0702	$6.96	J1931	$32.14	J7181	$15.52	J9202	$497.72
J0714	$92.05	J1940	$0.69	J7182	$1.31	J9205	$49.91
J0717	$8.02	J1950	$1,269.23	J7183	$0.97	J9206	$2.47
J0720	$38.54	J1955	$19.40	J7185	$1.27	J9207	$91.07
J0725	$22.62	J1980	$29.47	J7186	$1.06	J9208	$26.44
J0735	$13.71	J2001	$0.03	J7188	$3.18	J9209	$1.61
J0740	$623.27	J2010	$11.18	J7189	$2.15	J9211	$32.72
J0743	$6.14	J2060	$0.66	J7190	$1.07	J9214	$34.24
J0744	$1.24	J2150	$2.62	J7192	$1.25	J9217	$224.70
J0770	$19.20	J2175	$6.07	J7193	$1.15	J9218	$16.60
J0775	$48.76	J2210	$17.39	J7194	$1.47	J9225	$4,085.61
J0780	$9.69	J2250	$0.12	J7195	$1.50	J9226	$36,647.60
J0795	$9.04	J2260	$1.78	J7197	$3.32	J9228	$153.13
J0800	$3,946.50	J2270	$4.40	J7198	$1.90	J9245	$610.88
J0834	$39.82	J2274	$14.99	J7200	$1.32	J9250	$0.25
J0875	$14.95	J2300	$3.17	J7201	$3.11	J9260	$2.49
J0878	$0.33	J2310	$15.28	J7205	$2.08	J9263	$0.15
J0881	$3.85	J2315	$3.25	J7308	$390.98	J9264	$12.51
J0882	$3.85	J2323	$20.24	J7311	$341.62	J9266	$17,566.89
J0885	$11.03	J2326	$1,101.83	J7312	$200.03	J9267	$0.13
J0887	$1.80	J2353	$206.57	J7313	$490.87	J9268	$1,968.61
J0894	$7.49	J2354	$0.78	J7321	$81.57	J9271	$49.39
J0895	$8.52	J2357	$36.78	J7323	$145.08	J9280	$87.75
J0897	$19.28	J2360	$6.44	J7324	$143.40	J9285	$52.13
J1000	$21.89	J2400	$23.32	J7325	$11.41	J9293	$27.39
J1020	$3.70	J2405	$0.11	J7327	$769.51	J9299	$27.81
J1030	$6.25	J2407	$23.78	J7340	$219.45	J9301	$62.86
J1040	$11.93	J2425	$21.28	J7500	$0.66	J9302	$60.09
J1050	$0.56	J2430	$12.06	J7501	$238.19	J9303	$119.07
J1071	$0.02	J2469	$7.93	J7502	$2.34	J9305	$69.47
J1100	$0.14	J2501	$0.79	J7503	$1.33	J9306	$12.29
J1110	$57.66	J2502	$303.03	J7504	$2,066.02	J9307	$291.26
J1120	$17.19	J2503	$722.05	J7507	$0.39	J9308	$58.42
J1160	$5.42	J2505	$4,432.56	J7509	$0.36	J9312	$94.67
J1162	$3,780.19	J2507	$2,512.55	J7510	$0.09	J9315	$297.59
J1165	$0.85	J2510	$29.97	J7511	$768.56	J9320	$349.70
J1170	$2.68	J2515	$37.02	J7512	$0.01	J9328	$10.39
		J2545	$105.27	J7515	$0.70	J9330	$53.14
		J2550	$2.02	J7516	$49.25	J9340	$404.28

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