Medi-Cal Update

Clinics and Hospitals | September 2019 | Bulletin 540

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1. 2020 ICD-10-CM/PCS Codes Annual Update

Effective for dates of service on or after October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) has updated ICD-10-CM and ICD-10-PCS codes for the 2020 annual ICD-10 update.

Information and downloads for these codes can be found at the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update and Family PACT Update.

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2. Updated Policy for Postpartum Office Visits

Effective for dates of service on or after October 1, 2019, billing policy for local code Z1038 (postpartum visit) is limited to one in six months unless medical documentation is present. Any additional postpartum visits billed with Z1038 are required to include documentation of a medical or mental health postpartum risk factor or complication. The documentation should appear either in the Remarks field (Box 80)/Additional Claim Information field (Box 19) of the claim, or an attachment for reimbursement.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
preg early (4); preg glo (3); preg per (2); preg post (4)
Home Health Agencies/Home and Community-Based Services
Inpatient Services
preg post (4)
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3. EWC Covered Procedures Quick Reference Sheets Update

The CPT codes 10004, 10005, 10006, 10007 and 10008 have been updated on the following Every Woman Counts (EWC) quick reference sheets:

These forms can be found on the Every Woman Counts (EWC) Manuals, Forms and Worksheets page of the Medi-Cal website.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
ev woman (38–40)
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4. Manual Enrollment for PE4PW is Discontinued

Effective October 31, 2018, the Department of Health Care Services (DHCS) has discontinued the manual (paper) enrollment process for the Presumptive Eligibility for Pregnant Women (PE4PW) program. Claims for services provided on or after January 1, 2019, submitted with the paper MC 263 PE Proof of Eligibility identification card are not reimbursable by Medi-Cal.

MC 263 PE For Pregnancy

If a recipient presents this type of ID for services, the provider must inform them that the ID is invalid and the recipient can locate a provider to enroll them electronically by visiting the Presumptive Eligibility for Pregnant Women page of the DHCS website.

Recipients enrolled through the electronic PE4PW web page will have a printed Immediate Need card and a record in the Med-Cal Eligibility Data System (MEDS). Providers should check eligibility before providing services.

Medi-Cal providers who provide prenatal care are encouraged to apply to become a Qualified Provider (QP) by completing the Qualified Application for Presumptive Eligibility Participation and taking the required PE4PW Computer Based Training (CBT). Information about the PE4PW program is available on the Presumptive Eligibility for Pregnant Women page of the Medi-Cal website.

QPs using the manual enrollment process must discontinue use of the paper Presumptive Eligibility for Pregnant Women Program Application (MC 263) and confidentially destroy any remaining forms.

For questions concerning enrollment, CBT and other PE4PW issues, providers may email PE@dhcs.ca.gov.

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5. Antihemophilic Factor Jivi is a Medi-Cal Benefit

Effective for dates of service on or after October 1, 2019, HCPCS code J7208 (injection, Factor VIII, [antihemophilic factor, recombinant], PEGylated-aucl, [Jivi], 1 IU), is a Medi-Cal benefit. Code J7208 may be billed with modifiers U7 and 99 for physician assistant services and SA and SB for non-physician medical practitioner services, as well as modifier UD for all providers.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Pharmacy
blood (3)
Clinics and Hospitals
General Medicine
blood (3); non ph (13, 26)
Obstetrics
Rehabilitation Clinics
non ph (13, 26)
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6. National Correct Coding Initiative Quarterly Update for October 2019

The Centers for Medicare & Medicaid Services (CMS) are scheduled to routinely release the quarterly National Correct Coding Initiative (NCCI) in Medicaid payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and will be effective for dates of service on or after October 1, 2019.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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7. CHDP Gateway Access Issue Notification

Provider access to the Child Health and Disability Prevention (CHDP) Gateway may be impacted as a result of the multi-year, multi-phase project to transition CHDP providers from billing local codes on the PM 160 claim to billing national codes on the CMS-1500 or UB-04 claim form. It is anticipated most providers will not be impacted by the administrative updates; however, providers who are unable to access the Gateway should 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 regarding Gateway access issues to CHDPTransition@conduent.com.

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8. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Changes, effective July 1, 2019
NDC Labeler Code Contracting Company's Name
59310 TEVA RESPIRATORY, LLC

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (13)
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9. October 2019 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 29 – 30, 2019, at the Pasadena Convention Center in Pasadena, 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 October 15, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 15, 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 regional representative.

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

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10. 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.

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

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11. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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