PRIOR AUTHORIZATION: X-RAYS AND LIVER FUNCTION TESTS

 
  

The Wyoming Department of Health’s TB Program reimburses all medical services at the Medicaid billing rate.  Any service dated prior to November 1, 2010, will be reimbursed at the actual amount billed.

Current Medicaid billing rates for serviced covered by the TB Program are as follows:

 

CPT

Name

Critical Access
(CA)

General
(GEN)

Children's
(CH)

Practioner
(PP)

Wyoming Public Health Lab

71010

X-Ray Single

$83.02

$32.63

$70.36

$11.65

n/a

71020

X-Ray Double

$83.02

$32.63

$70.36

$15.76

n/a

36415

Venipuncture

$2.70

$2.70

$2.70

$2.70

n/a

80076

Liver Function Panel

$9.67

$9.67

$9.67

$9.67

n/a

71010.26

Single-Rad. Fee

n/a

n/a

n/a

$6.51

n/a

71020.26

Double-Rad. Fee

n/a

n/a

n/a

$7.88

n/a

86480, 86481

IGRA-

$77.93

$77.93

$77.93

$77.93

$40.00

 

Please call or email Canyon Hardesty (see upper right page) if you have any questions or concerns.Thank you.

 
The Prior Authorization Request (PAR) Form must be filled out and submitted to the Wyoming Department of Health TB Program before any agreement for payment can be made.
 
 
To access Prior Authorization Request Form, CLICK HERE.
Complete and then click submit to forward the form to the WY Dept of Health TB Program.
 
 
We thank you for your cooperation and welcome comments and questions.  Check back often for updates and changes.

 

LIVER FUNCTION RECOMMENDATIONS

 

Once patients have been identified and then tested for LTBI, they should receive an initial clinical evaluation. They should also receive follow-up evaluations at least monthly (if receiving isoniazid alone or rifampin alone) and at 2, 4, and 8 wk (if receiving rifampin and pyrazinamide). This evaluation should include questioning about side effects and a brief physical assessment checking for signs of hepatitis. Patients should be educated about the side effects associated with treatment of LTBI and advised to stop treatment and promptly seek medical evaluation when they occur.

Baseline laboratory testing is not routinely indicated for all patients at the start of treatment for LTBI (see Table 8). Patients whose initial evaluation suggests a liver disorder should have baseline hepatic measurements of serum aspartate aminotransferase (serum glutamic oxaloacetic transaminase) (AST [SGOT]) or alanine aminotransferase (serum glutamic pyruvic transaminase) (ALT [SGPT]) and bilirubin. Baseline testing is also indicated for patients with HIV infection, pregnant women, and women in the im mediate postpartum period (i.e., within 3 mo of delivery), persons with a history of chronic liver disease (e.g., hepatitis B or C, alcoholic hepatitis, or cirrhosis), persons who use alcohol regularly, and persons at risk for chronic liver disease. Baseline testing is not routinely indicated in older persons. However, such testing may be considered on an individual basis, particularly for patients who are taking other medications for chronic medical conditions. Active hepatitis and end-stage liver disease are relative contraindications to the use of isoniazid or pyrazinamide for treatment of LTBI.

Routine laboratory monitoring during treatment of LTBI is indicated for persons whose baseline liver function tests are abnormal and other persons at risk for hepatic disease. Laboratory testing may also be indicated for the evaluation of possible adverse effects that occur during the course of treatment (e.g., liver function studies for patients with symptoms compatible with hepatotoxicity or a uric acid measurement to evaluate complaints of joint pain). Some experts recommend that isoniazid should be withheld if transaminase levels exceed three times the upper limit of normal if associated with symptoms and five times the upper limit of normal if the patient is asymptomatic. (CLICK HERE for complete CDC article)