TO: HOSPITALS, AMBULATORY SURGICAL CENTERS, PHYSICIANS AND PHYSICIAN ASSISTANTS
FROM: RANDY W. MAY, Deputy Administrator
Division of Medicaid
Following Medicare’s guidelines, intestinal transplants are now covered by Idaho Medicaid, effective April 1, 2001. Pre-authorization review will be performed by PRO-West for ICD-9 code 46.97 and CPT codes 44133, 44135 and 44136. Transplant facilities must be Medicare approved. An updated Select Prior-Authorization List is attached.
No later than August 1, 2001, the following information must be included with Retrospective Review Requests that are faxed or mailed to PRO-West for telephonic reviews (for reviews of stays less than 15 days):
· History and Physical
· Discharge Summary
· Operative Report (if applicable)
This additional documentation will expedite the review process for your facility. An updated Retrospective Review Request Form is attached.
Questions regarding this information release can be directed to the PRO-West Contract Officer, Arlee Coppinger at (208) 334-5754.