I scoured the internet trying to find which diagnosis codes medicaid would accept to cover the ritalin. I came up with a few answers.
This link (page 5) says that methylphenidate is "Covered - Valid ICD-9 code must be written on the prescription."
AND No prior authorization is required
This one lists the acceptable codes for stimulants
This is what the above link says are acceptable diagnosis codes (without a prior authorization)
"ADD, ADHD, Narcolepsy, Organic brain syndrome, Traumatic brain injury, Treatment
resistant depression, Mental retardation if patient exhibits: injurious behavior, or is hyperactive or both, Severe sedation due to psychotropic medications, severe sedation due to chemotherapy medications. Please note, the Daytrana patch is not FDA indicated for adults, and Medicaid will not cover it past the age of 18."
She takes trazodone which according to my research is a psychtropic medication, and I am wondering if her onfi is also a psychotropic drug (that one I can't find specific info on...but other seizure meds are psychotropic drugs).
I called the nurse practitioner about my findings and she said she would have to talk to the Dr. She just kept saying...we can't just keep trying diagnosis codes until one works...she has to actually have the diagnosis. I kept saying I know...but here are the ones that would work (with out a prior authorization...so all I would need is a new prescription). I think when they were trying to get the prior auth they were putting in codes...but didn't bother to look up which codes would be accepted.
I believe she fits into this category (severe sedation due to psychotropic drugs). The nurse practitioner will talk to the Dr. about it.
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