Family PACT Update

November 2018 | Bulletin 134

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1. Family PACT Update: Cervical Cancer Screening and HPV Testing

Effective for dates of service on or after December 1, 2018, CPT code 87624 (infectious agent detection by nucleic acid [DNA or RNA]; Human Papillomavirus [HPV], high-risk types [eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68]) is reimbursable for female clients aged 21 years and older with modifier 33 for the Family Planning, Access, Care and Treatment (Family PACT) Program. Use of modifier 33 indicates the service was provided in accordance with a U.S. Preventive Services Task Force (USPSTF) recommendation. The service must be billed with the ICD-10-CM diagnosis code that identifies the contraceptive method for which the client is being seen. Additional ICD-10-CM diagnosis code Z11.51 (encounter for screening for human papillomavirus [HPV]) is required.

The USPSTF recommends screening for cervical cancer every three years with cervical cytology alone in women 21 to 29 years of age. For women 30 to 65 years of age, USPSTF recommends screening every three years with cervical cytology alone, every five years with high-risk human papillomavirus (hrHPV) testing alone or every five years with hrHPV testing in combination with cytology (co-testing).

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

Provider Manual(s) Page(s) Updated
Family PACT ben fam rel (6); ben grid (12)
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2. Corrected Reimbursement Rates for Select HCPCS Codes

Effective retroactively for dates of service on or after February 1, 2018, the Department of Health Care Services (DHCS) updates reimbursement rates for HCPCS codes S1090 (mometasone furoate sinus implant, 370 micrograms) and J7296 (levonorgestrel-releasing intrauterine contraceptive system, [Kyleena], 19.5 mg) to $795 and $908.97, respectively. The reimbursement rate for both codes was previously $0.

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.

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3. Family PACT Update: Copper IUC Reimbursable as a Pharmacy Benefit

Effective for dates of service on or after September 1, 2018, the copper intrauterine contraceptive (ParaGard T 380A) is reimbursable as a Family Planning, Access, Care and Treatment (Family PACT) pharmacy benefit. For additional information, providers may refer to the Physician-Administered Drugs section in Part 2 Medi-Cal Pharmacy provider manual.

Pharmacy-dispensed ParaGard T 380A is solely sourced by the ParaGard Specialty Pharmacy. For contact information, providers may refer to the ParaGard website. For ordering information, providers may refer to the PARAGARD Specialty PharmacySM section on the Welcome to the ParaGard Program website.

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

Provider Manual(s) Page(s) Updated
Family PACT pharmacy (4, 13)
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4. Provider Orientation

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 Provider Orientation training is delivered online and in person and includes information on comprehensive family planning, program benefits and services, client eligibility, provider responsibilities and compliance.

Each provider's service location is required to be certified for enrollment in the Family PACT Program. Applicants who are enrolled in Medi-Cal and in good standing or are pending Medi-Cal enrollment and who have submitted a Family PACT application packet may complete the Provider Orientation to certify a site for enrollment.

Each service location must designate one eligible representative to be the site certifier. The site certifier cannot certify multiple sites.

The medical director, physician, nurse practitioner or certified nurse midwife who is responsible for overseeing the family planning services rendered at the location to be enrolled is eligible to certify the site.

Provider Orientation details and registration information is posted on the Family PACT website at www.familypact.org.

Upcoming In-Person Orientation

Los Angeles
December 11, 2018
10:00 a.m. – 2:00 p.m.
California Endowment
1000 North Alameda Street
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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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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