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DOH Medicaid Update Website
Provides up-to-date changes that may affect your participation in the Medicaid Program.
 
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Provider Manuals > Physician Manual

Physician Manual

Manual Contents

Information for All Providers
Policy Guidelines
Billing Guidelines
Physician Billing Guidelines
General Professional Billing Guidelines
General Remittance Guidelines
Clinical Criteria Worksheets for Practitioner Administered Drugs
Prior Approval Guidelines
Prior Approval Business Location Chart
EPSDT/CTHP Manual for Child Health Plus A (Medicaid)
Preferred Diabetic Supply List (PDSL)
Enteral Formula Prior Authorization webinar
Fee Schedule Column Descriptions
Procedure Codes General Information



Procedure Codes & Fee Schedules

Fee Schedules: Medicine   Last updated on 3/28/2024
Fee Schedules: Drugs   Last updated on 3/28/2024
Procedure Codes: Medicine and Drugs   Last updated on 3/28/2024
Fee Schedules: Radiology   Last updated on 4/9/2024
Procedure Codes: Radiology   Last updated on 3/28/2024
Fee Schedules: Surgery   Last updated on 3/28/2024
Procedure Codes: Surgery   Last updated on 3/28/2024
Enhanced Program Fee Schedule   Last updated on 12/22/2022
Fee Schedules: Anesthesia   Last updated on 3/28/2024
Procedure Codes: Anesthesia   Last updated on 3/28/2024


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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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