Medi-Cal Update

Clinics and Hospitals | February 2020 | Bulletin 545

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1. Correction: 2020 HCPCS Policy Updates PDF Reposted with Updated Policy

A previously published Medi-Cal Update article titled “2020 HCPCS Annual Update” included an incorrect version of the 2020 HCPCS Policy Updates PDF. The correct 2020 updates to the HCPCS codes, along with updated policy for HCPCS code K1005, are available in the 2020 HCPCS Policy Updates PDF.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Orthotics and Prosthetics
Pharmacy
Therapies
dura cd fre (5)
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2. Medical Supply Billing Codes Are Not Yet Updated to DME Supply Billing Codes

A previously published Medi-Cal Update article titled “Policy for Medical Supply Billing Codes Updated to DME Supply Billing Codes” notified providers that, effective for dates of service on or after February 1, 2020, certain medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes, certain DME codes are added and certain medical supply codes policy is changed. The policy from that article will not be implemented at this time, including policy regarding benefit status and billing requirements. Until further notice, the following items continue to be reimbursable as medical supply codes and are not yet reimbursable as DME supply codes:

HCPCS Code Description
A4230 Infusion set for external insulin pump, non needle cannula type
A4231 Infusion set for external insulin pump, needle type
A4232 Syringe with needle for external insulin pump, sterile, 3 cc
A4483 Moisture exchanger, disposable, for use with invasive mechanical ventilation
A7002 Tubing, used with suction pump, each
A7003 Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
A7004 Small volume nonfiltered pneumatic nebulizer, disposable
A7006 Administration set, with small volume filtered pneumatic nebulizer
A7007 Large volume nebulizer, disposable, unfilled, used with aerosol compressor
A7008 Large volume nebulizer, disposable, prefilled, used with aerosol compressor
A7010 Corrugated tubing, disposable, used with large volume nebulizer, 100 ft
A7012 Water collection device, used with large volume nebulizer
A7013 Filter, disposable, used with aerosol compressor or ultrasonic generator
A7016 Dome and mouthpiece, used with small volume ultrasonic nebulizer
B4035 Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
S8186 Swivel adaptor

Until further notice, medical supplies HCPCS code A4223 (infusion supplies not used with external infusion pump, per cassette or bag) continues to be reimbursable for infusion supplies with or without an infusion pump. HCPCS code A4222 (infusion supplies for external drug infusion pump, per cassette or bag) is not yet reimbursable as a DME supply.

Until further notice, the following HCPCS codes are not yet reimbursable:

HCPCS Code Description
A4224 Supplies for maintenance of insulin infusion catheter, per week
A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer

Until further notice, the following medical supplies codes are no longer end-dated and continue to be reimbursable:

HCPCS Code Description
B9998 Extension set for enteral feeding
B9999 Infusion supplies not otherwise classified
S1015 IV tubing extension set

Providers are encouraged to check the Medi-Cal website regularly for updates.

Updated manual pages and the updated Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet reflecting this change will be released in a future Medi-Cal Update.

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3. Proprietary Laboratory Analyses (PLA) Codes Implementation in Progress

The Department of Health Care Services (DHCS) has received numerous inquiries regarding submitting claims using Proprietary Laboratory Analyses (PLA) codes. DHCS currently does not have the capability to process claims using PLA codes and is diligently working on system changes for the implementation of PLA codes. DHCS appreciates your patience during this time and apologizes for any inconvenience this may have caused.

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4. Neurofunctional Testing Reimbursement Rate Update

Effective retroactively for dates of service from July 1, 2014, through the current fiscal year, the reimbursement rates per state fiscal year are updated for CPT® code 96020 (neurofunctional testing selection and administration during noninvasive imaging functional brain mapping, with test administered entirely by a physician or other qualified health care professional [ie, psychologist], with review of test results and report) as follows:

State Fiscal Year Updated Medi-Cal Rate
2014 – 2015 $144.03
2015 – 2016 144.02
2016 – 2017 140.59
2017 – 2018 138.48
2018 – 2019 139.13
2019 – 2020 141.30

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

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5. Biovance is a New Medi-Cal Benefit

Effective for dates of service on or after March 1, 2020, HCPCS code Q4154 (Biovance, per square centimeter) is a Medi-Cal benefit.

An approved Treatment Authorization Request (TAR) is required for reimbursement.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
surg integ (4)
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6. Durolane Added as a Medi-Cal Benefit

Effective for dates of service on or after March 1, 2020, HCPCs code J7318 (Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg) has been added as a benefit.

A Treatment Authorization Request (TAR) is required for reimbursement.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitation Clinics
inject cd list (8); inject drug e-h (43–45)
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7. Clarification of Billing Codes for Initial Antepartum Office Visits

Effective for dates of service on or after March 1, 2020, only primary obstetrical providers are to bill with HCPCS codes Z1032 (initial antepartum office visit) and Z1034 (antepartum follow-up office visit). All other providers must bill with Evaluation and Management (E&M) consultation codes 99241 – 99245.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals altern (4); preg com exu (2); preg com lis (1); preg early (3, 4); preg ex ub (2, 11); preg glo (1); preg per cd (1); preg share (1); presum bill (15)
General Medicine
Obstetrics
altern (4); preg com exc (2, 5); preg com lis (1); preg early (3, 4); preg glo (1); preg per cd (1); preg share (1); presum bill (15)
Pharmacy presum bill (15)
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8. March 5, 2020 Medi-Cal Provider Seminar

The March Medi-Cal provider seminar is scheduled for March 5, 2020 at Concord Crowne Plaza Hotel in Concord, 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 (CA-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 February 17, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date of training. After February 17, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 claims 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 request a custom billing workshop, presented by a regional field representative. To schedule the regional representative for your area, providers must 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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9. March 2020 Medi-Cal Seminar

The March Medi-Cal provider seminar is scheduled for March 24, 2020, at the Flamingo Conference Resort and Spa in Santa Rosa, 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 new and experienced providers and billing staff, cover the following topics:

Providers must register by March 9, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date of training. After March 9, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks page of the Medi-Cal website.

Note:

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

Providers who 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 request a custom billing workshop presented by a field representative. To schedule the field representative for their area, providers must contact Provider Call Center (PCC) at 1-800-541-5555 and request to be contacted by a field representative.

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

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10. April 2020 Medi-Cal Provider Seminar

The April Medi-Cal provider seminar is scheduled for April 14–15, 2020, at the Riverside Convention Center in Riverside, 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 MMIS Fiscal Intermediary, 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 March 27, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After March 27th, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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. To contact the regional representative for your area, 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 page and refer to it often for current seminar information.

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11. Reminder: Screening for Adverse Childhood Experiences Is a Medi-Cal Benefit

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal benefit. Medi-Cal reimburses 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 California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics will also be able to receive these reimbursements, 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 reimbursed more than once per year, per provider. Screenings for individuals 21 years of age or older will not be reimbursed 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 or older. For individuals 18 or 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age or 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 Medi-Cal program and Managed Care Plans (MCPs) when billed with either of the two HCPCS codes below:

These codes may be billed to Medi-Cal directly even if the recipient has Other Health Coverage (OHC).

For fee-for-service Medi-Cal providers, screenings for ACEs are reimbursed at the Medi-Cal rate up to $29. For Medi-Cal MCPs, screenings for ACEs are reimbursed no less than $29 for each qualifying ACEs screening. Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the recipient and/or family and any clinically appropriate actions were documented. This documentation should remain in the recipient’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 screening reimbursement after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS launched www.ACEsAware.org, which includes information about DHCS’ provider training and other resources.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care Provider Trainings page of the DHCS website.

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.

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
oth hlth cpt (4)
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12. Childhood Developmental Screening Is a New Medi-Cal Benefit

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.

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 Transporation
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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13. 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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14. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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