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Clarification regarding ADHD diagnosis requirement

On October 1, 2018, the Mississippi Division of Medicaid (DOM) began requiring an FDA-approved indication or compendia-supported indication for each stimulant prescription.

It has come to DOM’s attention that the MississippiCAN pharmacy claims systems do not interface with the medical claims systems and may not  be able to  perform a search for diagnoses in the past 24 months of medical claims. The fee-for-service system is capable of performing this look-back function.

To ensure that stimulant prescriptions process without delays or the need for prior authorization, DOM advises providers to write the diagnosis and ICD-10 code on each of their patient’s ADHD prescriptions. Pharmacy providers must then enter the ICD-10 code on prescription claims.

A list of FDA-approved or compendia-supported indications covered by DOM, along with corresponding ICD-10 codes, can be found on DOM’s Pharmacy Resource website page.

For questions or more information, please contact the Office of Pharmacy at 601-359-5253, Option 4.