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THOMAS J. VILSACK, GOVERNOR DEPARTMENT OF HUMAN SERVICES

SALLY J. PEDERSON, LT. GOVERNOR KEVIN W. CONCANNON, DIRECTOR

INFORMATIONAL LETTER NO. 480

To: Iowa Medicaid Participating Providers – Family Planning Clinics

From: Iowa Department of Human Services

Date: December 27, 2005

Subject: Changes to the Fee Schedule for Provider Type 22

Effective: July 1, 2005

The Iowa Medicaid Enterprise (IME) has reviewed payment methodologies in effect in the past and has decided to change the payment structure for Family Planning providers.

Historically, the Department of Human Services had determined through medical review that the payments for specific CPT codes should be modified somewhat from the physician fee schedule on which the family planning fee schedule was based. At this time, the IME intends to remove those changes and pay family planning centers at the full rate that would be paid for the same services if such services were to be rendered in a physician’s office.

This change will be effective for services provided by Family Planning agencies on and after July 1, 2005. Claims submitted for these dates of service and received after January 1, 2006 will be paid at the amended rate in effect as of July 1, 2005.

As you know, we are also anticipating a 3% increase in the provider rate for services provided on and after July 1, 2005. All paid claims that have been previously paid at the prior rate for these services will be re-processed by the IME and a gross adjustment will be made to the provider. The provider should not have to perform any specific task to receive this adjustment. This re-processing will pick up both the 3% increase and any changes due to the action described in this letter.

Please be advised that some code payments will be decreased while many others will be increased. An updated fee schedule displaying the new rates will be placed on the IME website shortly. The web address is:

http://www.ime.state.ia.us/Reports_Publications/FeeSchedules.html

If you should have any questions, please contact provider services at 1-800-338-7909 or locally at 515-725-1004.