Medi-Cal Update

Expanded Access to Primary Care Program | January 2019 | Bulletin 532

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1. 2019 HCPCS Annual Update: Policy Updates

The 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2019 HCPCS 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 February 1, 2019. Providers should refer to the 2019 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
AIDS Waiver Program
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Psychological Services
Therapies
Vision Care
medi non hcp (2)
Audiology and Hearing Aids hear aid bill (3, 4); hear aid cd (1, 3); medi non hcp (2); tax (10)
Chronic Dialysis Clinics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12)
Clinics and Hospitals
General Medicine
chemo an over (2); chemo drug a-d (3, 8, 23, 24, 31); chemo drug e-o (7, 8, 18, 21); chemo drug p-z (9–12, 19, 20); inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); medne tele (5); modif used (12); non ph (12–14, 25–27); once (1); ophthal (16); radi dia ult (3); radi onc (7–9); surg eye (14); surg integ (5); surg nerv (3)
Durable Medical Equipment
Orthotics and Prosthetics
medi non hcp (2); tax (10)
Obstetrics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27); once (1); radi dia ult (3); radi onc (7–9)
Pharmacy inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); tax (10)
Rehabilitation Clinics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27)
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2. National Correct Coding Initiative Quarterly Update for January 2019

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after January 1, 2019.

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

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3. Authorized Drug Manufacturer Labeler Codes Update

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

Additions, effective January 1, 2019
NDC Labeler Code Contracting Company's Name
00254 PAR PHARMACEUTICAL INC.
10148 COTHERIX, INC.
16781 ONSET DERMATOLOGICS LLC
24689 APNAR PHARMA LP
42192 ACELLA PHARMACEUTICALS, LLC
46017 MYLAN CONSUMER HEALTHCARE, INC.
50228 SCIEGEN PHARMACEUTICALS, INC.
52856 PTC THERAPEUTICS, INC.
61145 REPHARM LLC
69292 AMICI PHARMACEUTICALS LLC
69557 SCILEX PHARMACEUTICALS
70127 GREENWICH BIOSCIENCES INC.
70428 DERMIRA, INC.
70594 XELLIA PHARMACEUTICALS USA, LLC
70677 MCKESSON CORPORATION
70726 ITF PHARMA, INC.
71258 PROGENICS PHARMACEUTICALS, INC.
71336 ALNYLAM PHARMACEUTICALS, INC.
71369 AKARX, INC.
71558 INSMED INCORPORATED
71717 MEGALITH PHARMACEUTICALS INC.
71773 TETRAPHASE PHARMACEUTICALS, INC.
71779 VERASTEM, INC.
71904 AMICUS THERAPEUTICS, INC.
72126 AKCEA THERAPEUTICS, INC.
72205 NOVADOZ PHARMACEUTICALS, LLC
72245 FORTE BIO-PHARMA LLC
72511 AMGEN 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 (4, 5, 7–11, 13, 18–20)
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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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