According to Georgia Medicaid guidelines, enteral nutrition supplies and equipment must be reported with the purchase modifier NU (New equipment). PDF Attachment 4.19 - B State Georgia POLICY AND METHODS FOR ESTABLISHING Before sharing sensitive or personal information, make sure youre on an official state website. Learn moreabout how we provide comprehensive support for members. The payment rate for out-of-state enrolled hospitals will not exceed 65% of covered charges. Acthar Gel) (PDF), Ribavirin (Copegus, Moderiba, Rebetol, Ribasphere) (PDF), Rifabutin (Mycobutin), Rifabutin/Omeprazole/Amoxicillin (Talicia) (PDF), Risperidone Long-Acting Injection (Risperdal Consta) (PDF), Rituximab (Rituxan), Rituxan/Hyaluronidase (Rituxan Hycela) (PDF), Sapropterin Dihydrochloride (Kuvan) (PDF), Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors (PDF), Sucroferric Oxyhydroxide (Velphoro) (PDF), Tezacaftor/Ivacaftor; Ivacaftor (Symdeko) (PDF), Timothy grass pollen allergen extract (Grastek) (PDF), Tobramycin (Bethkis, Kitabis Pak, TOBI, TOBI Podhaler) (PDF), Tofacitinib (Xeljanz, Xeljanz Poor girl.XR) (PDF), Topical Diclofenac (Solaraze, Flector) (PDF), Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase (PDF), Treprostinil (Orenitram, Remodulin, Tyvaso) (PDF), Triamcinolone ER Injection (Zilretta) (PDF), triptorelin pamoate (Trelstar, Triptodur) (PDF), Valproate Sodium for Intravenous Injection (Depacon) (PDF), vincristine sulfate liposome injection (Marqibo) (PDF), Voretigene neparvovec-rzyl (Luxturna) (PDF), Age Limit for Tazarotene (Tazorac, Arazlo) (PDF), Benzodiazepine Use in Pediatric Seizure Disorders (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone, Zubsolv) (PDF), Dasabuvir Ombitasvir Paritaprevir Ritonavir (Viekira XR, Viekira Pak)(PDF), Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir (Viekira XR, Viekira Pak) (PDF), Epinephrine Injection Device - Quantity Limit Override (PDF), Factor IX Complex Human (Bebulin, Profilnine) (PDF), Factor VIII/von Willebrand Factor Complex (Human - Alphanate, Humate-P, Wilate) (PDF), Human Growth Hormone (Somapacitan, Somatropin) (PDF), euprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levofloxacin (Levaquin) in Pediatric Community Acquired Pneumonia(PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF), Olanzapine Long-Acting Injection (Zyprexa Relprevv) (PDF), Pediatric Benzodiazepine Use in Chemotherapy Induced Nausea and Vomiting CINV(PDF), Psychotropic Medication Continuity of Care (COC)(PDF), Request for Medically Necessary Drug Not on the PDL (PDF), Sofosbuvir/Velpatasvir/Voxilaprevir (Vosevi) (PDF), Topical Steroid Use For Eosinophilic Esophagitis (PDF), Topical Tretinoin in Adult Acne Vulgaris (PDF), Hydroxyprogesterone Caproate (Makena) (PDF), Lost, Stolen, Spilled or Broken Medications(PDF), Maximum Allowable Cost (MAC) Requirement(PDF), Cost to Charge Adjustments on Clean ClaimReviews (PDF), Distinct Procedure Modifiers Policy (PDF), E&M Bundling with Labs and Radiology (PDF), E&M Services Billed with Treatment Room Revenue Codes (PDF), Hospital Visit Codes Billed with Labs (PDF), Leveling of Care: Evaluation and Management Overcoding (PDF), Leveling of Emergency Room Services (PDF), Modifier to Procedure Code Validation (PDF), Multiple Diagnostic Cardiovascular Procedure Payment Reduction (MDCR) (PDF), Multiple Procedure Reduction: Ophthalmology (PDF), Non-obstectrical Pelvic and Transvaginal Ultrasounds (PDF), Not Medically Necessary Inpatient Service (PDF), Polymerase Chain Reaction Respiratory Viral Panel Testing (PDF), Problem Oriented Visits with Preventative Services (PDF), Problem Oriented Visits with Surgical Procedures (PDF), Unbundling Adjustments on Clean Claim Reviews (PDF), Leveling Professional Fees for Emergency Room Services (PDF), Multiple Procedure Payment Reduction: Therapeutic Services (PDF), Reporting the Global Maternity Package (PDF), Problem Oriented Visits with Preventative Services(PDF), Fluticasone/Vilanterol (Breo Ellipta) (PDF).

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