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Nurse Practitioner Provider Communications

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Provider Manuals > Nurse Practitioner Manual


Nurse Practitioner Manual

Manual Contents

Information for All Providers
Policy Guidelines
Fee Schedule
Enhanced Program Fee Schedule
Fee Schedule Column Descriptions
Procedure Codes
Billing Guidelines
Nurse Practitioner Billing Guidelines
General Professional Billing Guidelines
General Remittance Guidelines
Clinical Criteria Worksheets for Practitioner Administered Drugs
EPSDT/CTHP Manual for Child Health Plus A (Medicaid)
Preferred Diabetic Supply List (PDSL) - Prime Therapeutics State Government Solutions
Enteral Formula Prior Authorization webinar


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Participating Drug Companies for Medicaid Drug Rebate Program

Click here for the list of Medicaid Drug Rebate Program Participating Drug Companies

The list of participating drug companies provides a tool for practitioners to identify drug labelers/vendors that participate in the Medicaid Drug Rebate Program. Please note that the first 5 digits of the National Drug Code (NDC) represent the labeler/vendor. If the labeler code is not on this list, the labeler's drug is not reimbursable by Medicaid. Please refer to this list periodically, as the list of covered labelers/vendors is continually being updated. For billing and reimbursement of practitioner administered drugs, refer to your Provider Manual Procedure Code and Fee Schedule sections for Drugs, and Provider Communications, listed above.

Formulary File

Medicaid Pharmacy List of Reimbursable Drugs (Formulary File)

As a reference tool for pharmacies and prescribers, the Formulary File contains prescription and over the counter drugs, as well as glucometer and home blood glucose test strip products, covered through the Pharmacy benefit. For billing and reimbursement of practitioner administered drugs, refer your Provider Manual Procedure Code and Fee Schedule sections for Drugs, and Provider Communications, listed above.

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