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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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This information is not part of your provider manual, however, it may be useful information and is placed here for your convenience.
 
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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
Prior Approval Guidelines
Prior Approval Business Location Chart
EPSDT/CTHP Manual for Child Health Plus A (Medicaid)
Preferred Diabetic Supply List (PDSL)
Fee Schedule Column Descriptions
Procedure Codes General Information



Procedure Codes & Fee Schedules

Last updated on 1/1/2013 Primary Care Rate Increase (PCRI) Fee Schedule
Last updated on 4/1/2014 Fee Schedules Medicine
Last updated on 4/1/2014 Fee Schedules Drugs
Last updated on 4/1/2014 Procedure Codes Medicine and Drugs
Last updated on 4/1/2014 Fee Schedules Radiology
Last updated on 4/1/2014 Procedure Codes Radiology
Last updated on 4/1/2014 Fee Schedules Surgery
Last updated on 4/1/2014 Procedure Codes Surgery
Last updated on 4/1/2010 Enhanced Program Fee Schedule
Last updated on 11/18/2010 Fee Schedules Anesthesia
Last updated on 4/1/2011 Procedure Codes Anesthesia


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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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