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Corrections to 2018 CPT-4/HCPCS Annual Update

February 16, 2018

A previously published Medi-Cal Update added, changed and deleted CPT-4 and HCPCS codes for the 2018 annual update, effective February 1, 2018, and the 2017 quarterly update, effective October 1, 2017. Updates to this policy are as follows:

The following HCPCS codes are not Presumptive Eligibility for Pregnant Women (PE4PW) benefits:

C9014 C9029 J0565 J2326 J9023
C9015 C9488 J0604 J2350 J9203
C9016 C9492 J0606 J3358 J9285
C9024 C9493 J1428 J7345 Q2040
C9028 C9738 J1555 J9022  

Durable Medical Equipment
HCPCS codes E0953 and E0954 are non-taxable and must be billed with modifiers NU, NURB/RBNU or RR.  Modifiers U7, J4 and 99 are allowed.

HCPCS code E0953 has a frequency limit of two every 12 months for any provider.  A Treatment Authorization Request (TAR) may be submitted to override the frequency limit.

HCPCS code E0954 has a frequency limit of two in five years for any provider.  A TAR may be submitted to override the frequency limit.

Medicine
CPT-4 code 94617 is split-billable with an approved TAR and must be billed with modifier TC when billing only for the technical component, and modifier 26 when billing only for the professional component. When billing for both the technical and professional component, no modifier is required. Modifier 99 must not be billed in conjunction with modifier 26 or modifier TC, otherwise the claim will be denied.

Physician Administered Drugs
The correct ICD-10-CM diagnosis codes for HCPCS code J2326 includes the range G12.20 – G12.25.

No frequency limitation is applicable to HCPCS code J7296.

Radiology
CPT-4 codes 71045 – 71048, 74018, 74019 and 74021 are split-billable with an approved TAR and must be billed with modifier TC when billing only for the technical component, and modifier 26 when billing only for the professional component. When billing for both the technical and professional component, no modifier is required. Modifier 99 must not be billed in conjunction with modifier 26 or modifier TC, otherwise the claim will be denied.

Surgery
CPT-4 code 36483 is exempt from the modifier 51 cutback.

CPT-4 code 58575 requires a hysterectomy informed consent form to be attached to the claim; otherwise the claim will be denied.

The correct policy is reflected in the following PDF documents: