Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | August 2019 | Bulletin 539

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1. Telehealth Policy Update for Medi-Cal and Family PACT Programs

Effective for dates of service on or after July 1, 2019, telehealth policy is updated pursuant to Assembly Bill 415 (Logue, Chapter 547, Statutes of 2011), known as the Telehealth Advancement Act of 2011. Benefits or services covered under the Medi-Cal and Family PACT programs, identified by CPT or HCPCS codes and subject to all existing Medi-Cal and Family PACT coverage and reimbursement policies, including any Treatment Authorization Request (TAR) requirements, may be provided via a telehealth modality, if all of the following are satisfied:

Health care providers are required to document Place of Service code “02” on the claim, which indicates that services were provided or received through a telecommunications system.

Modifier GT is no longer required. Covered benefits or services provided via a telehealth modality are reimbursable when billed in one of two ways:

In addition, CPT code 99451 (interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician) is reimbursable for e-consults.

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics may also bill their respective services via a telehealth modality.

Modifier 95 is required to bill for Local Educational Agency (LEA) Medi-Cal Billing Option Program services provided via a telehealth modality.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers ind health (9–14); rural (11–16)
Chronic Dialysis Clinics modif used (2)
Clinics and Hospitals ind health (9–14); medne tele (1–11); modif used (2); rural (11–16); tar and non cd9 (9)
Family PACT ben clinic (6)
General Medicine medne tele (1–11); modif used (2); tar and non cd9 (9)
Inpatient Services tar and non cd9 (9)
Local Educational Agency loc ed bil (12); loc ed bil cd (1, 3–6, 19, 20); loc ed serv spe (6–15); loc ed tele (3)
Obstetrics modif used (2); tar and non cd9 (9)
Rehabilitation Clinics modif used (2)
Vision Care pro serv (6)
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2. Extended End Date for Proposition 56 Supplemental Payments

Effective for dates of service on or after July 1, 2019, the Department of Health Care Services (DHCS) has extended the end date to December 31, 2021, for supplemental payments allocated under the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56).

Previously implemented supplemental payment amounts shall continue for the following CPT codes, HCPCS codes and accommodation codes:

Physician Services
Codes Amount Codes Amount Codes Amount
99201 $18.00 99214 $62.00 99384 $83.00
99202 $35.00 99215 $76.00 99385 $30.00
99203 $43.00 90791 $35.00 99391 $75.00
99204 $83.00 90792 $35.00 99392 $79.00
99205 $107.00 90863 $5.00 99393 $72.00
99211 $10.00 99381 $77.00 99394 $72.00
99212 $23.00 99382 $80.00 99395 $27.00
99213 $44.00 99383 $77.00    

Family Planning, Access, Care and Treatment (Family PACT)
Codes Amount Codes Amount Codes Amount
99201 $81.18 99204 $244.26 99213 $85.08
99202 $121.59 99211 $42.56 99214 $132.95
99203 $202.77 99212 $64.17    

Intermediate Care Facility for the Developmentally Disabled (ICF/DD)
Accommodation Codes Amount Accommodation Codes Amount
41 and 43
(1 – 59 beds)
$15.47 62 and 64 $12.47
61 and 63 $10.75 66 and 69 $22.30

Intermediate Care Facility for the Developmentally Disabled/Continuous Nursing (ICF/DD-CN)
Codes Amount Codes Amount
T2033 U8 $35.58 T2033 U9 $39.32

Women's Health (Pregnancy/Abortion)
Codes Amount Codes Amount
59840 $149.15 59841 $345.57

HIV/AIDS Waiver
Codes Amount Codes Amount Codes Amount
G0299 $9.12 G0156 $4.51 T2022 $134.06
G0300 $6.61 S5130 $3.35 T2025 $76.63
90837 $47.02 S9470 $30.13    

Free-Standing Pediatric Subacute Facility
Accommodation Codes Amount Accommodation Codes Amount
91 $132.92 94 $132.92
92 $132.92 95 $132.92
93 $132.92 96 $132.92

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

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3. PM 160 Information Only Discontinued for FQHCs, RHCs and IHS-MOA Clinics

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics bill Early and Periodic Screening, Diagnostic and Treatment/Child Health and Disability Prevention (EPSDT/CHDP) services using the UB-04 claim. Effective September 1, 2019, FQHCs, RHCs and IHS-MOA clinics will no longer submit the Confidential Screening/Billing Report Information Only (PM 160 Information Only) with claims to fulfill reporting purposes. Instead, these providers will fulfill reporting requirements by including informational lines on their claims. Required reporting data will be extrapolated from the informational lines.

Providers submitting paper claims can refer to a sample UB-04 claim populated with informational lines in the Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Examples provider manual section. Instructions for submitting informational lines on electronic claims is available in the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual, “Special Billing Instructions: Federally Qualified Health Centers, Rural Health Clinics, and Indian Health Services-Memorandum of Agreement” section.

Additionally, beginning September 1, 2019, providers should no longer order PM 160 Information Only forms.

Providers are encouraged to watch for CHDP updates in the NewsFlash area on the Medi-Cal website and subscribe to the Medi-Cal Subscription Service (MCSS) to receive timely notifications related to CHDP by completing the MCSS Subscriber Form.

Providers with questions or concerns may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

Email Address for Questions/Concerns
Providers may submit questions or concerns about the preceding to CHDPTransition@conduent.com.

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Clinics and Hospitals
ind health (8); rural (9)
CHDP chdp trans (1)
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4. September 2019 Medi-Cal Provider Seminar

The September Medi-Cal Provider Seminar is scheduled for September 17 – 18, 2019, at the Visalia Convention Center in Visalia, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) for Medi-Cal conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by September 3, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 3, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.

Note:

Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative web page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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5. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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