Medi-Cal Update

Clinics and Hospitals | December 2019 | Bulletin 543

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1. October 2019 HCPCS Quarterly Update: Policy Updates

The October 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the Quarter 4 HCPCS Policy (Medi-Cal) PDF. Only those codes representing Medi-Cal benefits effective October 1, 2018, are included in the list of updates.

Please refer to the 2018 HCPCS Level II code book for complete descriptions of these codes.

Providers should refer to the HCPCS Annual Update page for ongoing updates.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12)
Clinics and Hospitals
General Medicine
chemo drug a-d (14, 15, 21); chemo drug e-o (2, 3, 17–19, 21–24); chemo drug p-z (15, 25, 26); inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25); ophthal (15–17, 19–22); surg integ (4, 5, 9)
Obstetrics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Rehabilitation Clinics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Pharmacy inject an over (1); inject cd list (2–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 9, 13, 17, 22–24)
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2. 2020 CPT Annual Update

The 2020 updates to the Current Procedural Terminology (CPT) codes are available in the 2020 CPT Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2020. Please refer to the 2020 CPT code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
cardio (9, 10); chemo an over (1); epsdt chdp school (5); eval (31); inject an over (1); inject cd list (9); medne neu (3, 4, 8); medne non (1); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); ophthal (2, 4, 10); ophthal cd (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); surg cardio (9); surg eye (1); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Obstetrics eval (31); inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Rehabilitation Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); vaccine (4)
Chronic Dialysis Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); vaccine (4)
Inpatient tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10)
Local Educational Agencies loc ed bil cd (8, 10, 11, 14, 22); loc ed serv nurs (5); loc ed serv physican (5); loc ed serv psych (7); modif app (12, 13)
Vision Care modif app (12, 13); modif used vc (2); pro serv (4, 11, 17, 19, 20); pro serv cd (7, 8); rates max optom (2)
Pharmacy inject an over (1); inject cd list (9); presum bill (10, 11)
AIDS Waiver Program modif (3); modif app (12, 13)
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3. ICD-10-CM Diagnosis Code No Longer Required for Fulvestrant Injection

Effective for dates of service on or after December 1, 2019, HCPCS code J9395 (injection, fulvestrant, 25 mg) no longer requires an ICD-10-CM diagnosis code for reimbursement.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
chemo drug e-o (7)
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4. New Medi-Cal Policy Information on Reimbursement for Childhood Developmental Screening

Effective for dates of service from January 1, 2020, through December 31, 2021, Medi-Cal reimburses providers for developmental screenings with funds from the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56). The Fiscal Year 2019 – 2020 Governor’s budget included funds to be allocated for payments to support developmental screenings for children enrolled in full-scope Medi-Cal coverage under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. The developmental screenings are performed at well-child visits at 9, 18 and 30 months of age, and when medically necessary based on developmental surveillance. Providers must use a standardized screening tool that meets the criteria set forth by the American Academy of Pediatrics (AAP) and the Centers for Medicare & Medicaid Services (CMS). Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the child’s family and/or caregiver, and any clinically appropriate actions were documented. This documentation should remain in the beneficiary’s medical record and be available upon request.

Developmental screenings are reimbursed under the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with CPT code 96110 (developmental screening, with scoring and documentation, per standardized instrument) without the use of modifier KX. For fee-for-service Medi-Cal program providers, developmental screenings are reimbursed at a rate of $59.90 in addition to the amount paid for the office visit. For Medi-Cal MCPs, developmental screenings are reimbursed at a rate of $59.90 in addition to any reimbursement the network provider would normally receive.

For Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics providers, developmental screenings are reimbursed at a rate of $59.90 in addition to their Prospective Payment System (PPS) reimbursement and all-inclusive rate. Additional information about how FQHC/RHC/IHS-MOA providers should bill for development screening will be released in a future Medi-Cal Update.

On December 11, 2019, from 1:00 – 2:00 p.m. PST, DHCS will hold a webinar for Medi-Cal providers and stakeholders to learn more about the developmental screening policy. For more information on how to register for the webinar, go to https://register.gotowebinar.com/register/162758910122848524

If necessary, an Erroneous Payment Correction (EPC) will be implemented to reprocess any claims erroneously denied for dates of service on or after January 1, 2020. Providers should continue to bill their claims timely and check for updates on the Medi-Cal website.

Updated manual pages reflecting this change will be released in a future Medi-Cal Update.

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Chronic Dialysis Clinics
Durable Medical Equipment
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Rehabilitation Clinics
Therapies
Vision Care
modif app (11)
Clinics and Hospitals
General Medicine
modif app (11); prev (14)
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5. Screening for Adverse Childhood Experiences Is a Medi-Cal Covered Benefit

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal covered benefit. Medi-Cal will begin reimbursing for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with Proposition 56 funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services (IHS) – Memorandum of Agreement (IHS-MOA) 638 Clinics will also be able to receive these payments, in addition to their Prospective Payment System (PPS) and all-inclusive per-visit reimbursement.

Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be paid more than once per year, per provider. Screenings for individuals 21 years of age and older will not be paid more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age and older. For individuals 18 and 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age and older is used, it must contain questions on the 10 original categories of ACEs to qualify.

ACEs screenings will be reimbursed in both the fee-for-service and managed care delivery systems when billed with either of the two HCPCS codes below:

In the fee-for-service delivery system, providers will be reimbursed at the Medi-Cal rate up to $29. In the managed care delivery system, Medi-Cal managed care plans will reimburse network providers no less than $29 for each qualifying ACEs screening. Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family and any clinically appropriate actions were taken. This documentation should remain in the beneficiary’s medical record and be available upon request. The Department of Health Care Services (DHCS) will release additional information in a future announcement about how FQHCs, RHCs and IHS-MOA clinics can bill for trauma screening.

In order to be eligible for the trauma payment after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS will launch http://www.ACEsAware.org which will post information on DHCS’ provider training and other resources.

On December 4, 2019, at 12:15 p.m. (PST), the Office of the California Surgeon General and DHCS will host an ACES Aware Initiative Unveiling webinar to share details of the new ACEs Aware Initiative for Medi-Cal providers.

On December 11, 2019, from 1 p.m. to 2 p.m. (PST), DHCS will hold a webinar for Medi-Cal providers and stakeholders to learn more about the trauma screening policy and trauma-informed provider training. For more information about how to register for the webinar, providers may visit to the DHCS Stakeholder Update: Trauma & Developmental Screenings webinar registration web page.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care webpage.

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6. Podiatry Services Restored as Medi-Cal Covered Benefits

Effective for dates of service on or after January 1, 2020, podiatry services previously eliminated as part of the optional benefits exclusion are reinstated as full Medi-Cal benefits.

In addition, Welfare and Institutions (W&I) code, Section 14133.07 was recently amended to remove two visit limit and to remove the same TAR requirements for services by podiatrists as for physicians and surgeons.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Audiology and Hearing Aids
Chiropractic
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Inpatient Services
Long Term Care
Medical Transportation
Obstetrics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
opt ben exc (1–4, 6, 7, 13)
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7. Audiology and Speech Therapy Services Restored as Medi-Cal Benefits

Effective for dates of service on or after January 1, 2020, audiology and speech therapy services previously eliminated as part of the optional benefits exclusion are reinstated as full Medi-Cal benefits.

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

Provider Manual(s) Page(s) Updated
Chiropractic
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Inpatient Services
Long Term Care
Medical Transportation
Obstetrics
Pharmacy
Psychological Services
Vision Care
opt ben exc (1–4, 6–8, 13, 16–18)
Audiology and Hearing Aids
Adult Day Health Care Centers
Rehabilitation Clinics
Therapies
audio (1, 3, 6); opt ben exc (1–4, 6–8, 13, 16–18); speech (1)
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8. 2019 ICD-10 Procedure Code Policy Added to Provider Manual

Effective retroactively for dates of service on or after October 1, 2018, the following 2019 ICD-10 Procedure Coding System (PCS) codes are updated in the provider manual:

Providers need take no action. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

Information and downloads for ICD-10-PCS codes can be found at the ICD-10 page of the Centers for Medicare & Medicaid Services (CMS) website.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
medne (7)
Inpatient Services medne (7); ob ub ex drg (4)
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9. Time-Limited Supplemental Payment for Specific Family Planning Services

Effective for dates of service from July 1, 2019, through December 31, 2021, supplemental payments will be allocated under the California Healthcare Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) for the following specified Medi-Cal family planning services under the Medi-Cal Fee-for-Service program. An Erroneous Payment Correction will be implemented reprocess affected claims.

Procedure Code Description Supplemental Payment Amount
J7296 Levonorgestrel-releasing intrauterine contraceptive system, (Kyleena), 19.5 mg $2,727
J7297 Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg 2,053
J7298 Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg 2,727
J7300 Intrauterine copper contraceptive 2,426
J7301 Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg 2,271
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies 2,671
J3490U8 Medroxyprogesterone acetate, 150 mg 340
J7303 Contraceptive supply, hormone containing vaginal ring, each 301
J7304 Contraceptive supply, hormone containing patch, each 110
J3490U5 EMERG CONTRACEPTION: Ulipristal acetate 30 mg 72
J3490U6 EMERG CONTRACEPTION: Levonorgestrel 0.75 mg (2) & 1.5 mg (1) 50
11976 Removal, implantable contraceptive capsules 399
11981 Insertion, non-biodegradable drug delivery implant 835
58300 Insertion of intrauterine device (IUD) 673
58301 Removal of intrauterine device (IUD) 195
81025 Urine pregnancy test, by visual color comparison methods 6
55250 Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) 521
58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography 371
58555 Hysteroscopy, diagnostic (separate procedure) 322
58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants 1,476
58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral 1,515
58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach 1,115
58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) 978
58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 843
58671 Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) 892
58700 Salpingectomy, complete or partial, unilateral or bilateral (separate procedure) 1,216
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10. Incontinence Medical Supply Claims Billable with Select HCPCS Codes

Effective for dates of service on or after January 1, 2020, incontinence medical supply claims for Other Health Coverage (OHC) Code of “F”, Medicare Part C Health Plan are billable to Medi-Cal with HCPCS Codes A4554, T4521–T4537 and T4540–T4544.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
General Medicine
Medical Transportation
Obstetrics
Outpatient Services
oth hlth cpt (2)
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11. National Correct Coding Initiative Quarterly Update for January 2020

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 January 1, 2020.

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

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12. Policy for Medical Supply Billing Codes Updated to DME Supply Billing Codes

Effective for dates of service on or after February 1, 2020, the following medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes: HCPCS codes A4222, A4230 – A4232, A4483, A7002 – A7004, A7006 – A7008, A7010, A7012, A7013, A7016, B4035 and S8186. Note that codes A4230 – A4232 and A7008 are not benefits.

These HCPCS codes that describe items used in the operation of DME will no longer be medical supply codes on the List of Medical Supplies Billing Codes, Units and Quantity Limits. These HCPCS codes must be billed as DME supply codes.

Updates to Medical Supply Codes
Effective for dates of service on or after February 1, 2020, medical supply HCPCS codes are updated as follows:

A4223

Infusion supplies not used with external infusion pump, per cassette or bag. Use to bill all necessary supplies that are not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to administrative sets and syringes, tubing, extension tubing, connecting devices and port caps) for the administration, without a pump, of non-insulin drugs.

Bill one (1) quantity unit per each administrative/infusion set/kit or per each separate item (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 30 units per 27-day period require authorization.

Documentation of product cost (an invoice, manufacturer’s catalog page or price list) is required as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement.

Refer to DME supply HCPCS code A4222 for infusion supplies used with an external infusion pump.

B4034 Enteral feeding supplies; syringe fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by syringe and maintain the feeding site.
B4036

Enteral feeding supplies; gravity fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by gravity and maintain the feeding site.

For claims using HCPCS code B4034 and B4036, bill one (1) quantity unit per each administrative/supply set/kit or per each separate item, (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 31 units per 27-day period require authorization.

HCPCS code B4034 and B4036 require documentation of product cost (an invoice, manufacturer’s catalog page or price list) as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement.

Note:

HCPCS code B4035, enteral feeding supplies (pump fed), is updated to a DME supply code.

Effective for dates of service on or after February 1, 2020, HCPCS codes B9998, B9999 and S1015 will be end-dated. Providers must bill the items using the following codes:

Updates to DME Supply Codes
HCPCS codes A4230 – A4232 and A7008 are no longer benefits. The table below specifies policy for new DME supply codes A4483, A7002 – A7004, A7006, A7007, A7010, A7012, A7013, A7016, B4035 and S8186. In addition, policy for codes A4222, A4224, A4225 and E0574 is as follows.


HCPCS Code
Description Taxable/Non-Taxable Frequency Limit, Any Provider
A4222 * + Infusion supplies for external drug infusion pump, per cassette or bag Non-taxable --
A4224 * + ^ Supplies for maintenance of insulin infusion catheter, per week Non-taxable 1 per week
A4225 * + ^ Supplies for external insulin infusion pump, syringe type cartridge, sterile, each Non-taxable 15 per month
A4483 * + ^ Moisture exchanger, disposable, for use with invasive mechanical ventilation Non-taxable (no change) 31 per month
A7002 * + Tubing, used with suction pump, each Non-taxable 4 per month
A7003 * + Administration set, with small volume nonfiltered pneumatic nebulizer, disposable Taxable (no change) 2 per month
A7004 * + Small volume nonfiltered pneumatic nebulizer, disposable Taxable (no change) 2 per month
A7006 * + Administration set, with small volume filtered pneumatic nebulizer Taxable (no change) 1 per month
A7007 * + Large volume nebulizer, disposable, unfilled, used with aerosol compressor Taxable (no change) 1 in 2 months
A7010 * + Corrugated tubing, disposable, used with large volume nebulizer, 100 ft Taxable (no change) 1 in 2 months
A7012 * + Water collection device, used with large volume nebulizer Taxable (no change) 2 per month
A7013 * + Filter, disposable, used with aerosol compressor or ultrasonic generator Taxable (no change) 2 per month
A7016 * + Dome and mouthpiece, used with small volume ultrasonic nebulizer Taxable (no change) 2 per year
B4035 * + ^ Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape Taxable 31 per month
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer Taxable (no change) 1 in 5 years
S8186 * + Swivel adaptor Non-taxable (no change) 2 in 12 months

*  This code must be billed with modifier NU. Modifiers RB and RR are not allowed.
+  This code is for patient-owned equipment.
^  This code must be billed using the “from-through” (block-billing) method when billing for more than one day of service.

HCPCS code A7016 may be reimbursed only when used with code E0574. Authorization for rental of code E0574 may be granted in increments of up to three months, both for the initial authorization and for reauthorization. Authorization for purchase of code E0574 may be granted for one device every five years. Claims for code E0574 must include modifier NU, RR or RB.

HCPCS code S8186 is not covered by Medicare and should be billed to Medi-Cal directly.

HCPCS codes A4224 and A4225 are reimbursable under the Presumptive Eligibility for Pregnant Women (PE4PW) program.

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Chronic Dialysis Clinics
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Psychological Services
Rehabilitation Clinics
Vision Care
medi non hcp (1)
Audiology and Hearing Aids medi non hcp (1); tax (6–8, 10, 12, 13)
Durable Medical Equipment dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); tax (6–8, 10, 12, 13)
General Medicine
Obstetrics
Clinics and Hospitals
medi non hcp (1); presum bill (12)
Orthotics and Prosthetics dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1); tax (6–8, 10, 12, 13)
Pharmacy dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); presum bill (12); tax (6–8, 10, 12, 13)
Therapies dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1)
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13. Updates to Incontinence Creams and Washes

Effective for dates of service on or after January 1, 2020, incontinence creams and washes require authorization and are no longer restricted to recipients under 21 years of age. Products on the List of Contracted Incontinence Creams and Washes are reimbursable with an approved Treatment Authorization Request (TAR) or Service Authorization Request (SAR) for recipients 5 years of age or older. The List of Incontinence Medical Supply Billing Codes is also updated to reflect this change. The Optional Benefits Exclusion section of the appropriate Part 2 manual will be updated in a future Medi-Cal Update.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Long Term Care
Pharmacy
incont (1, 2, 4–7, 9, 12)
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14. 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 December 1, 2019
NDC Labeler Code Contracting Company’s Name
00642 EXELTIS USA, INC.

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 (5, 21)
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15. 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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16. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

allergy (1)
altern (1)
anest (1)
anest ub (2)
blood (9)
cal child sar (3)
cal child ser (4)
cardio (1, 13)
cardio bil ub (2)
chemo an over (2)
chemo drug a-d (2)
chemo drug e-o (7)
chemo drug p-z (1)
correct (1)
correct cod (2)
dental (1)
dial chr (9)
dial end (3)
dura spe (6)
eloa (10)
eloa ub (4)
eval (1, 17)
ev woman exub (2)
fam planning (2)
gene coun (2)
genetic (6)
hcpcs (1)
heroin cd (2)
hyst (2)
immun (1)
immun cd (1)
inject an over (4)
inject bil ub (2)
inject an over (4)
inject drug a-d (5)
inject drug i-m (19)
inject drug n-r (8)
inject hydra (1)
medi cr op (23, 26, 27)
medi non cha (1)
medi non cpt (1, 2)
medi non hcp (4)
modif used (1)
non inject (5)
non ph (4)
non ph ub (2)
once (1)
ophthal (1)
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