Family PACT Update

September 2017 | Bulletin 120

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1. Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)

A new DUR Educational Article titled “Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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2. 2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines

A new DUR Educational Article titled “2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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3. ACA's Nondiscrimination Policy Applies to Family PACT

Section 1557 of the Patient Protection and Affordable Care Act (ACA) prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities. In effect since 2010, Section 1557 builds on long-standing federal civil rights laws: Title VI of the Civil Rights Act of 1964; Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973 and the Age Discrimination Act of 1975.

Effective July 18, 2016, the Health and Human Services (HHS) Office for Civil Rights issued its final rule implementing Section 1557 at Title 45 Code of Federal Regulations (CFR) Part 92. The rule applies to any health program or activity, any part of which receives federal financial assistance, an entity established under Title I of the ACA that administers a health program or activity, and HHS. In addition to other requirements, Title 45 CFR Part 92.201, requires:

For more information about the application and requirements of the final rule implementing Section 1557, providers should contact their representative professional organizations. They may also visit the Section 1557 of the Patient Protection and Affordable Care Act web page of the HHS website to find sample materials and other resources.

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

Provider Manual(s) Page(s) Updated
Family PACT prov res (1)
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4. Family PACT Update: KX Modifier Facilitates Claims for Transgender Services

An article published in the July 2017 Medi-Cal Update titled KX Modifier Facilitates Claims for Transgender Services informed providers that, effective for dates of service on or after August 1, 2017, modifier KX (requirements specified in the medical policy have been met) may be used to facilitate claim processing in instances where the patient's gender conflicts with the billed procedure code. The patient's medical record must support medical necessity for the procedure.

Providers may already override a gender conflict with an approved Treatment Authorization Request (TAR) when the gender on the claim conflicts with the billed procedure code. Use of modifier KX introduces an alternative method to facilitate claims processing without requiring an approved TAR. The use of modifier KX will not override other policy requirements for an approved TAR.

This policy also applies to the Family Planning, Access, Care and Treatment (Family PACT) Program.

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

Provider Manual(s) Page(s) Updated
Family PACT ben clinic (5); prog stand (3)
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5. 58661 and 58700 New Benefits for Family PACT and TAR Removed for Medi-Cal

Effective for dates of service on or after October 1, 2017, CPT-4 codes 58661 (laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and 58700 (salpingectomy, complete or partial, unilateral or bilateral) are Family Planning, Access, Care, and Treatment (Family PACT) Program benefits.

CPT-4 codes 58661 and 58700 are reimbursable for females only with ICD-10-CM diagnosis code Z30.2 (encounter for sterilization). Sterilization Consent Form (PM 330) is required. If CPT-4 codes 58661 and 58700 are elective sterilization procedures, there is no Treatment Authorization Request (TAR) requirement under the Family PACT and Medi-Cal programs.

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 (20)
Family PACT ben fam (39, 40); ben grid (7)
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6. 2017 CPT-4/HCPCS Codes Annual Update for Family PACT

The 2017 updates to the Current Procedural Terminology - 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes are effective for the Family Planning, Access, Care, and Treatment (Family PACT) Program  for dates of service on or after October 1, 2017. The updates are as follows:

Terminated CPT-4 Code Description Replacement
CPT-4 Code
Description
99144 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time; 99152 Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time, patient age 5 years or older
99145 each additional 15 minutes intra-service time 99153 each additional 15 minutes intra-service time (List separately in addition to code for primary service)

Additionally, the following HCPCS code descriptions have been updated.

HCPCS Code Description
J7297 Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg.
J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg.
J7301 Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (4, 8)
Family PACT ben fam (24, 30, 39, 50); ben grid (4, 24); drug (2, 6)
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7. Family PACT Updates HPV Testing Policy

Effective for dates of service on or after October 1, 2017, ICD-10-CM diagnosis codes R87.810 (cervical high risk papillomavirus [HPV] DNA test positive) and R87.820 (cervical low risk human papillomavirus [HPV] DNA test positive) are reimbursable in combination with CPT-4 code 87624 (human papillomavirus [HPV], high-risk types) for Family Planning, Access, Care and Treatment (Family PACT) providers. This laboratory test covers women ages 30 through 65 for follow-up co-testing at one and three years from initial screening results of negative cytology with a positive HPV test.

These codes must be billed with the ICD-10-CM diagnosis code that identifies the contraceptive method for which a client is seen, as listed in the Family PACT Policies, Procedures and Billing Instructions manual: Z30.011, Z30.013, Z30.015 – Z30.018, Z30.02, Z30.41, Z30.42, Z30.430 – Z30.433, Z30.49 and Z98.51.

Testing policy for ICD-10-CM diagnosis code Z11.51 (encounter for screening for HPV) in combination with CPT-4 code 87624 is not changed.

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (6, 28); ben grid (12); lab (29)
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8. Family PACT Adds ICD-10-CM Diagnosis Code for Chlamydia Trachomatis Testing

Effective for dates of service on or after October 1, 2017, the Family Planning, Access, Care, and Treatment (Family PACT) Program adds ICD-10-CM diagnosis code A56.4 (chlamydial infection of pharynx) as reimbursable when billed with CPT-4 code 87491 (chlamydia trachomatis, amplified probe technique).

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (7); ben grid (13); lab (26)
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9. Family PACT Adds ICD-10-CM Diagnosis Codes for Postprocedural Hematoma

Effective for dates of service on or after November 1, 2017, the following ICD-10-CM diagnosis codes are reimbursable for the Family Planning, Access, Care, and Treatment (Family PACT) Program:

ICD-10-CM Diagnosis Code Description
L76.32 Postprocedural hematoma of skin and subcutaneous tissue following other procedure
N99.840 Postprocedural hematoma of a genitourinary system organ or structure following a genitourinary system procedure

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam (27, 46, 47, 52); lab (10–12, 37)
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10. Update to Reimbursement Rates for Clinical Laboratory Services

Effective for dates of service on or after July 1, 2017, Medi-Cal reimbursement rates for clinical laboratory services are updated.

No action is required of providers. Affected claims will be reprocessed via an Erroneous Payment Correction.

For more information, providers may refer to the Medi-Cal Rates page on the Medi-Cal website.

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11. Clinical Review: Drug-Induced QT Interval Prolongation

A new DUR Educational Article titled “Clinical Review: Drug-Induced QT Interval Prolongation” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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12. Provider Orientation

Family PACT

Medi-Cal providers applying to become a Family Planning, Access, Care and Treatment (Family PACT) provider are required to attend a Provider Orientation per Welfare and Institutions Code (W&I Code), Section (§) 24005(k). The Family PACT Provider Orientation provides an overview of the Family PACT Program, provider enrollment process, program standards and benefits and client eligibility and enrollment.

Solo or group providers or primary care clinics are eligible to apply for enrollment in the Family PACT Program if they currently have a National Provider Identifier (NPI) and are enrolled in Medi-Cal in good standing.

The medical director, physician, nurse practitioner or certified nurse midwife responsible for overseeing the family planning services to be rendered at the site to be enrolled is eligible to certify the site. Site certifiers shall sign a statement affirming responsibility.

The Family PACT Provider Orientation is delivered in two parts. Part one consists of an online orientation that must be completed prior to attending a part two in-person orientation. Medi-Cal providers who wish to enroll in the Family PACT Program will be required to complete both the online orientation and attend the in-person orientation. The Family PACT Provider Orientation is open to all site staff.

Complete the orientation process by following three simple steps:

  1. Visit: http://www.ofpregistration.org/ to register and create a profile in the Office of Family Planning Learning Management System (LMS). Once your profile has been set up, you are ready to proceed with the orientation.
  2. Complete part one of the orientation. Part one must be completed in order to register for the (part two) in-person orientation. Print the Certification of Completion when you have completed the online orientation.
  3. Complete part two by attending the in-person orientation. Register through the LMS and select an in-person orientation session. Site certifiers must attend the in-person orientation and are required to present photo identification during registration.

Upcoming In-Person Orientation

Los Angeles Oakland Los Angeles
October 3, 2017 October 25, 2017 December 5, 2017
10:00 a.m. – 2:00 p.m. 10:00 a.m. – 2:00 p.m. 1:00 p.m. – 5:00 p.m.
California Endowment California Endowment California Endowment
1000 North Alameda Street 2000 Franklin Street 1000 North Alameda Street
Los Angeles, CA  90012 Oakland, CA  94612 Los Angeles, CA  90012

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at ProviderServices@dhcs.ca.gov if you have any questions regarding the orientation process.

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13. October 2017 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 17, 2017, at the Embassy Suites in San Luis Obispo, California. Providers can access a class schedule for the seminar by visiting the Provider Training 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, Department of Health Care Services (DHCS) and Conduent, the Fiscal Intermediary 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 3, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 3, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page on 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 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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14. Get the Latest Medi-Cal News: Subscribe to MCSS Today

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

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15. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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