April 1, 2010: Instructions have changed for Fields
17 and 17a. These fields are no longer required. EPSDT services are
identified by EP or TS modifiers used in Field 24D. Rendering
provider information is recorded in Field 24J.
December 29, 2008: Field 33b is now labeled as
Conditional instead of Required. API users must complete this field,
but it is required for NPI users only when they utilize a taxonomy
November 19, 2008: Instructions have changed for
Field 24F. While most providers bill their usual and
customary charge in this field, the Medicaid Services Manual (MSM)
specifies that certain services must be billed based on other
criteria (e.g., physician administered drugs must be billed at the
Average Wholesale Price (AWP) and per MSM Chapter 300,
radiopharmaceuticals must be billed at 100% of wholesale invoice
price). It is important to be familiar with the MSM chapter(s) that
apply to the services you provide.
The field requirement for Field 32 has
changed from "Required" to "Conditional." Some services are provided
in the recipient's home and therefore do not require a servicing
facility address. The field requirement for Field 32a has
been changed from "Required" to "Not Required" as this information
is not required in order to process the claim.
November 1, 2007: Instructions have changed for
Fields 17, 24A, 24D, 24H and 32a. Provider types 25, 38, 41, 48, 57
and 58 must complete Field 17 for EPSDT referrals.