States must also be able to meet requirements imposed by both the federal government and state legislatures. State legislatures commonly mandate coverage of special services, which often have no corollary in the commercial market, for the Medicaid population that need to be tracked and reimbursed differently. When state laws are passed, there needs to be a responsive mechanism to provide a coding structure for these services. Absent a comprehensive and timely national solution, state Medicaid agencies have had to rely on local codes to perform their business. Attachment A contains a complete listing of the categories of local codes utilized by state Medicaid programs.
Local codes allow providers quicker, more consistent pricing and payment for services.
Dealing with a governmental program and low reimbursement rates is a BIG factor for providers. Local Codes allows us to use specific codes for individual manufacturers, which allows our providers to know exactly what they are prescribing. Facilitates adequate and timely reimbursement. Permits coverage of services for which there is no national code. Matches local practices better than national codes.