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Provider : Peachcare For Kids®

 

PeachCare for Kids ® Rate Increase
 

Effective for dates of services on and after April 1, 2012 an increase has been instituted for physician service provider rates paid for selected Evaluation and Management (E&M) codes billed for Peach Care for Kids® members.  These (E&M) codes were increased to 100% of the FY 2011 Medicare rates (Atlanta Region). This action will also increase Peach Care for Kids® inpatient hospital provider payment rates for selected Diagnosis Related Group (DRG) codes by 15%. Beginning June 1, 2012, WellCare of Georgia will begin reimbursing providers for the additional rate increase for dates of service on or after April 1, 2012. For claims submitted prior to June 1, 2012 with dates of service on or after April 1, 2012, an automatic reconciliation will take place; no action from the provider is necessary. Please note, resubmission may delay payments. 
 

E&M Codes: Increase to 100% of the 2011 Medicare Rate (Atlanta Region)

 

Office Visit/Outpatient
99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99217

 

Hospital Care
99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239

 

Emergency
99281, 99282, 99283, 99284, 99285, 99291, 99292,

 

Nursing Facility Care
99305, 99306, 99307, 99308, 99309

 

Home Visit
99343, 99344, 99347, 99348, 99349

 

Prolonged Service Office
99354, 99355, 99356, 99357

 

Behavioral Change Smoking
99406, 99407

 

Newborn/Pediatric
99460, 99461, 99462, 99463, 99466, 99469, 99471, 99472, 99475, 99476, 99477

 

CHAMPUS DRG Codes: 15% Increase
001, 003, 026, 068, 070, 091, 098, 167, 184, 279, 295, 297, 298, 321, 322, 371, 373, 395, 396, 410, 422, 426, 430, 450, 451, 564

 

Should you have questions regarding this change in reimbursement, please feel free to contact Provider Services at 866-231-1821 or your Provider Relations representative. As always we thank you for the excellent care you provide to our members.
 

Last modified: 05/18/2012
 

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