Family PACT Update

August 2010 | Bulletin 35

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1. Medi-Cal Training Seminars

Mark your calendar for the upcoming Medi-Cal Training Seminar in your area. Download the flyer (PDF).

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2. Family PACT HCPCS and CPT-4 Codes Annual Update

Family PACT

Effective for dates of service on or after September 1, 2010, HCPCS code A4264 ( permanent implantable contraceptive intratubal occlusion device[s] and delivery system) is a Family PACT (Planning, Access, Care and Treatment) program benefit.

Policy Updates

Code Replacement
CPT-4 code 86781 (antibody; Treponema pallidum) is replaced by code 86780. All existing program policies apply to the new code.

Description Changes
The following CPT-4 codes have changes in the description only:

CPT-4 Code Description
83986 pH; body fluid, not otherwise specified
86592 Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART)
86593 Syphilis test, non-treponemal antibody; quantitative

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

Provider Manual(s) Page(s) Updated
Family PACT ben grid (1–6, 8); ben prim (6, 27–28, 31); ben sec (7–9); lab (5, 9, 10)
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3. Family PACT Manual Updates

Family PACT

The following items are updated in the Family PACT Policies, Procedures and Billing Instructions manual:

Provider Manual(s) Page(s) Updated
Family PACT ben sec (4); client elig cert (12); client elig det (10)
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4. Sterilization Billing Instructions Modified

The following information appeared in the July 2010 Medi-Cal Update bulletin article titled “Family PACT HCPCS and CPT-4 Codes Annual Update.”

Policy Updates
Code A4264 replaces CPT-4 code 58565 ( hysteroscopic surgical placement of micro-insert[s])billed with modifiers 50 and 52

Effective for claims with dates of service on or after September 1, 2010, the following changes regarding code 58565 are Family PACT policy.

The information above is modified as follows: CPT-4 code/modifier combinations 58565-50 and 58565-52 are not being deleted. Effective for dates of service on or after September 1, 2010, these code combinations will not be used to bill for the Essure device, but will be used to bill for the procedure: hysteroscopy, surgical, with bilateral (modifier 50) or unilateral (modifier 52) fallopian tube cannulation to induce occlusion by placement of permanent implants, and the associated primary surgeon services.

Modifier AG Exception
Previously, providers billed for the fallopian tube cannulation procedure with CPT-4 code 58565 in combination with modifier AG (primary surgeon services). Standard billing policy requires providers to bill primary surgeon services with modifier AG. However, billing for code 58565 will be an exception to this rule. Claims submitted with code 58565 in combination with modifier AG will not be processed and will be returned to the provider.

Billing for CPT-4 Code 58565
Providers will bill code 58565 either with modifier 50 (for bilateral procedure to insert the Essure micro-insert device, and the associated primary surgeon services) or 52 (for unilateral procedure to insert the Essure micro-insert device, and the associated primary surgeon services). These modifiers were brought into use to help automate claims processing. A Consent Form (PM 330) is required with the claim.

Providers no longer need to document whether the procedure was bilateral or unilateral in the Remarks field ( Box 80) on the UB-04 claim or Reserved for Local Use field (Box 19) on the CMS-1500 claim, or on an attachment. With the use of modifiers 50 and 52 this step is no longer necessary.

The method for billing supplies for the sterilization procedure will not change. Providers will bill for the supplies with code 58565 in conjunction with either modifier ZM (supplies and drugs for surgical procedures with other than general anesthesia or no anesthesia) or ZN (supplies and drugs for surgical procedures with general anesthesia).

Claim Correction
Providers who mistakenly bill code 58565 with modifier AG may correct the claim with a Resubmission Turnaround Document (RTD).

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

Provider Manual(s) Page(s) Updated
Family PACT ben prim (29, 31)
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5. Emergency Contraceptive Packet Added as New Benefit

Family PACT

Effective for dates of service on or after June 1, 2010, Plan B ® One-Step (levonorgestrel 1.5 mg) emergency contraceptive packet is a new Family PACT (Planning, Access, Care and Treatment) Program benefit. The packet is billed with HCPCS code X7722. Pharmacy dispensing is limited to one tablet per dispensing for a total of six tablets in any 12-month period and for females only. Clinic dispensing is limited to two tablets per dispensing for a total of six tablets in any 12-month period and for females only.

This information is reflected in the following provider manual:  

Provider Manual(s) Page(s) Updated
Family PACT ben grid (13); ben prim (4); drug (3); pharmacy (5)
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6. DHCS Warehouse Closure

The Department of Health Care Services (DHCS) warehouse located at 1037 North Market Boulevard, Suite 9, Sacramento, CA 95834, that housed DHCS and California Department of Public Health (CDPH) forms, was closed. Most of the forms that were available at the warehouse may be downloaded or printed from the Medi-Cal Forms page. Providers should review the appropriate section of the provider manual for any forms that are not listed on the Forms page.

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7. Sterilization Consent Form Ordering

Sterilization Consent Forms (PM 330) (English on one side, Spanish on the other) may be ordered by calling the Telephone Service Center (TSC) at 1-800-541-5555. Providers must supply their NPI number when ordering the form(s). The following information also may be requested:

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Inpatient Services
Obstetrics
ster (8)
Family PACT prov res (7)
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