What are the Electronic Health Record (EHR) Incentive Programs?
The EHR incentive programs were established by the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery & Reinvestment Act of 2009. The programs aim to transform the nation’s health care system and improve the quality, safety and efficiency of patient health care by increasing the use of electronic health records. Providers and hospitals will need to use federally-certified EHR technology to participate in the Medicare and Medi-Cal EHR incentive programs.

The Medi-Cal EHR Incentive Program is administered by the Department of Health Care Services (DHCS). Nationally, the Medicare EHR Incentive Program is administered by the federal Centers for Medicare & Medicaid Services (CMS). Professional practitioners and hospitals that are ineligible for the Medi-Cal EHR Incentive Program may be eligible for the Medicare EHR Incentive Program. Professionals can participate in only one of these two programs, while hospitals can participate in both, as long as they meet all other eligibility requirements.

EHR Incentive Program Provider Registration
The EHR Incentive Programs: Registration and Attestation page of the CMS website is now available. Providers can use this central website to get information about the programs, eligibility requirement details and to link to an online registration system.

Two-Step Registration Process for the Medi-Cal EHR Incentive Program:

• Step 1: Register on the CMS website
• Step 2: Register on the Medi-Cal EHR Provider Incentive Portal (ePIP) website. Online registration for providers through ePIP begins in March 2011.

EHR INCENTIVE PROGRAM ELIGIBILITY AND PAYMENTS
The following is a summary of the principal eligibility requirements and incentive payments for the Medi-Cal EHR Incentive Program. Providers can review the EHR Incentive Programs: Eligibility page on the CMS website for more information.

Eligible Professionals

• Physicians
• Nurse practitioners
• Certified nurse midwives
• Optometrists
• Dentists
• Physician assistants who are working in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant

In order for a professional provider to qualify for the Medi-Cal EHR Incentive Program in 2011, the provider must demonstrate 30 percent Medi-Cal patient volume over a 90-day period in 2010 using either of two proportional formulas. Pediatricians can establish eligibility by demonstrating a 20 percent Medi-Cal patient volume.

• Formula 1:
   Total Medi-Cal Encounters
  Total All Patient Encounters
• Formula 2:
  Total Patients Assigned to a Medi-Cal Capitated Panel* + Total Medi-Cal Encounters
  Total Patients Assigned to a Capitated Panel* + Total Patient Encounters

* Note:

In order to be counted in either the numerator or denominator, capitated panel patients must have had at least one encounter in the year preceding the 90-day period selected for determining eligibility.

Providers practicing in FQHCs or RHCs can add Healthy Families, uninsured and partial pay patient encounters to the numerator of either formula, in order establish the required 30 percent (or 20 percent for pediatricians) patient volume.

Incentive Payments: Eligible Professionals

• Maximum incentive payments are $63,750 over six years.
• The first year payment is $21,250 if a provider adopts, implements or upgrades CMS-certified EHR technology or demonstrates meaningful use of previously implemented federally certified EHR technology.
• Incentive payments will be made in 5 subsequent years if the provider demonstrates meaningful use of federally certified EHR technology by submitting reports on several specified administrative and clinic objectives during those years.
• Payments need not be made in consecutive years but must begin by 2016 and must end in 2021.
• When registering for the incentive program with CMS, providers may assign their incentive payments to their employer or other entity if the employer or other entity has a valid contractual arrangement allowing the entity to bill and receive payment for the provider’s professional services. Such assignment of payments must be entirely voluntary for the provider.
• Pediatricians qualifying with 20 to 29 percent patient volumes will have their incentive payments reduced by 33.3 percent.

Eligible Hospitals

• Acute care hospitals (including critical access hospitals and cancer hospitals) are eligible if all of the following requirements are met:
• The CMS certification number’s last four digits are within the range 0001–0879 or 1300–1399.
• The average length of stay is 25 days or fewer.
• Ten percent or more of discharges are attributable to Medi-Cal patients.
• Children’s hospitals are eligible regardless of the percentage of Medi-Cal discharges or the average length of stay.

Incentive Payments: Eligible Hospitals
Hospitals are eligible for incentive payments beginning at a base of $2 million and adjusted for patient volume and other factors. Hospital payments will be determined as a lump sum and distributed over four years using the formula 50 percent, 30 percent, 10 percent and 10 percent respectively.

Hospital incentive payments will be based on a formula specified in the statute, as described in the document titled Medicaid Hospital Incentive Payment Calculations (pdf) on the CMS website.

Meaningful Use
Professionals and hospitals are expected to demonstrate meaningful use by submitting reports on a set of administrative and clinical objectives. During the first year of meaningful use, submission of reports can be by attestation but in subsequent years must be submitted electronically from the EHR.

“Meaningful use” is defined as the use of certified EHR technology to:

• Improve quality, safety, efficiency and reduce health disparities
• Engage patients and families in their health care
• Improve care coordination
• Improve population and public health
• All the while maintaining privacy and security

More specific information can be found on the CMS website’s Meaningful Use page.

Federally Certified EHR Technology
In order to receive EHR incentive payments, providers must use EHR technology that has been approved by the federal Office of the National Coordinator for Health Information Technology (ONC) as meeting national standards. The ONC is in the process of evaluating and certifying both complete EHRs and modular EHRs that carry out specific functions. The list of approved technologies is changing frequently. Providers can obtain up-to-date information on ONC’s Certified Health IT Product List page.

Provider Resources
The HITECH Act created Health Information Technology Regional Extension Centers (RECs) to provide “on-the-ground assistance” to help providers to successfully adopt, implement, upgrade and achieve meaningful use of EHRs within two years. In California, the federally designated RECs include:

• California Health Information Partnership and Services Organization (CALHIPSO)
• L.A. Care Health Plan – HITEC-LA
• CalOptima
• California Rural Indian Health Board

Further Information
Federal EHR information: Electronic Health Records and Meaningful Use page on the CMS website.
Medi-Cal EHR Information: Medi-Cal EHR Provider Incentive Portal (ePIP) website.

The code conversion of interim billing codes for maternal care services will not be implemented on April 1, 2011, as stated in previous Medi-Cal Updates. Providers should continue billing for maternal care services according to the existing instructions in the Medi-Cal provider manual until further notice.

Effective for dates of service on or after April 1, 2011, the Department of Health Care Services (DHCS) will discontinue the use of current Medi-Cal interim codes X9922, X9924, X9926, X9928, X9930, X9932, X9934, X9936, X9938, X9940, X9942, X9944, X9946, X9948, X9950, X9952, X9954, X9956, X9958, X9960, X9962, X9964, X9966, X9968 and X9970 for physician subacute care services. These interim codes will be replaced by HIPAA-compliant CPT-4 codes and a HCPCS code modifier to comply with the provisions of HIPAA of 1996, Public Law 104-191, Code of Federal Regulations, Title 45, Part 162.1000.

The proposed national codes and modifier are no longer available for review and comments. The public forum begins on October 1, 2010, and closed at 5 p.m. on November 15, 2010. Providers must not bill the new coding standards until they are instructed to do so in future Medi-Cal Updates.

The following changes are effective April 1, 2011:

Interim Code	Interim Code Description	Interim Code Rate	Proposed National Code Modifier	National Code Rate	Billing Instructions
X9922	Initial subacute care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity	Procedure Type N: $34.30 Procedure Type P: $30.60	99221 – Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $34.30 Procedure Type P: $30.60	• Use modifier U2 to identify subacute level of care
X9924	Initial subacute care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity	Procedure Type N: $73.20 Procedure Type P: $65.20	99222 – Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $73.20 Procedure Type P: $65.20	• Use modifier U2 to identify subacute level of care
X9926	Initial subacute care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity	Procedure Type N: $80.10 Procedure Type P: $71.40	99223 – Initial hospital care, per day, for the evaluation and management of a patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $80.10 Procedure Type P: $71.40	• Use modifier U2 to identify subacute level of care
X9928	Subsequent subacute care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; and Medical decision making that is straightforward or of low complexity	Procedure Type N: $28.60 Procedure Type P: $25.50	99231 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused interval history; A problem focused examination; and Medical decision making that is straightforward or of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $27.50 Procedure Type P: $24.50	• Use modifier U2 to identify subacute level of care
X9930	Subsequent subacute care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; and Medical decision making of moderate complexity	Procedure Type N: $37.80 Procedure Type P: $33.60	99232 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused interval history; An expanded problem focused examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $37.80 Procedure Type P: $33.60	• Use modifier U2 to identify subacute level of care
X9932	Subsequent subacute care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A detailed interval history; A detailed examination; and Medical decision making of high complexity	$45.80	99233 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components:< A detailed interval history; A detailed examination; and Medical decision making of high complexity and U2 – Medicaid Level of Care 2, as defined by each state	$45.80	• Use modifier U2 to identify subacute level of care
X9934	Subacute care discharge day management	$22.90	99238 – Hospital discharge day management; 30 minutes or less 99239 – Hospital discharge day management; more than 30 minutes and U2 – Medicaid Level of Care 2, as defined by each state	$37.60 $53.40	• Use modifier U2 to identify subacute level of care
X9936	Office consultation, for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making	Procedure Type N: $30.60 Procedure Type P: $30.60	99241 – Office consultation, for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $30.60 Procedure Type P: $30.60	• Use modifier U2 to identify subacute level of care
X9938	Office consultation, for a new or established patient, which requires these three key components: An expanded problem focused history; A expanded problem focused examination; and Straightforward medical decision making	Procedure Type N: $30.60 Procedure Type P: $30.60	99242 – Office consultation, for a new or established patient, which requires these three key components: An expanded problem focused history; A expanded problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $47.20 Procedure Type P: $47.20	• Use modifier U2 to identify subacute level of care
X9940	Office consultation, for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity	Procedure Type N: $51.00 Procedure Type P: $51.00	99243 – Office consultation, for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $59.50 Procedure Type P: $59.50	• Use modifier U2 to identify subacute level of care
X9942	Office consultation, for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity	$71.40	99244 – Office consultation, for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	$81.40	• Use modifier U2 to identify subacute level of care
X9944	Office consultation, for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity	$71.40	99245 – Office consultation, for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity and U2 – Medicaid Level of Care 2, as defined by each state	$102.20	• Use modifier U2 to identify subacute level of care
X9946	Initial subacute care consultation, for a new or established patient, that requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making	Procedure Type N: $30.60 Procedure Type P: $30.60	99251 – Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $27.86 Procedure Type P: $27.86	• Use modifier U2 to identify subacute level of care
X9948	Initial subacute care consultation, for a new or established patient, that requires these three key components: An expanded problem focused history; A expanded problem focused examination; and Straightforward medical decision making	Procedure Type N: $30.60 Procedure Type P: $30.60	99252 – Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; A expanded problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $33.46 Procedure Type P: $32.46	• Use modifier U2 to identify subacute level of care
X9950	Initial subacute care consultation, for a new or established patient, that requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity	Procedure Type N: $51.00 Procedure Type P: $51.00	99253 – Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $46.44 Procedure Type P: $46.44	• Use modifier U2 to identify subacute level of care
X9952	Initial subacute care consultation, for a new or established patient, that requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity	$71.40	99254 – Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	$65.01	• Use modifier U2 to identify subacute level of care
X9954	Initial subacute care consultation, for a new or established patient, that requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity	$71.40	99255 – Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity and U2 – Medicaid Level of Care 2, as defined by each state	$86.25	• Use modifier U2 to identify subacute level of care
X9956	Follow-up subacute care consultation, for an established patient, that requires at least two of these three key components: A problem focused history; A problem focused examination; and Medical decision making that is straightforward or of low complexity	$12.20	99231 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: A problem focused history; A problem focused examination; and Medical decision making that is straightforward or of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $27.50 Procedure Type P: $24.50	• Use modifier U2 to identify subacute level of care
X9958	Follow-up subacute care consultation, for an established patient, that requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity	$19.40	99232 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $37.80 Procedure Type P: $33.60	• Use modifier U2 to identify subacute level of care
X9960	Follow-up subacute care consultation, for an established patient, that requires at least two of these three key components: Detailed interval history; Detailed examination; and Medical decision making of high complexity	$30.60	99233 – Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: Detailed interval history; Detailed examination; and Medical decision making of high complexity and U2 – Medicaid Level of Care 2, as defined by each state	$45.80	• Use modifier U2 to identify subacute level of care
X9962	Confirmatory subacute care consultation, for a new or established patient, that requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making	$30.60	99251 – Inpatient consultation for a new or established patient, which requires these three key components: A problem focused history; A problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $27.86 Procedure Type P: $27.86	• Use modifier U2 to identify subacute level of care
X9964	Confirmatory subacute care consultation, for a new or established patient, that requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making	$30.60	99252 – Inpatient consultation for a new or established patient, which requires these three key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $33.46 Procedure Type P: $32.46	• Use modifier U2 to identify subacute level of care
X9966	Confirmatory subacute care consultation, for a new or established patient, that requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity	$51.00	99253 – Inpatient consultation for a new or established patient, which requires these three key components: A detailed history; A detailed examination; and Medical decision making of low complexity and U2 – Medicaid Level of Care 2, as defined by each state	Procedure Type N: $46.44 Procedure Type P: $46.44	• Use modifier U2 to identify subacute level of care
X9968	Confirmatory subacute care consultation, for a new or established patient, that requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity	$71.40	99254 – Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity and U2 – Medicaid Level of Care 2, as defined by each state	$65.01	• Use modifier U2 to identify subacute level of care
X9970	Confirmatory subacute care consultation, for a new or established patient, that requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity	$71.40	99254 – Inpatient consultation for a new or established patient, which requires these three key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity and U2 – Medicaid Level of Care 2, as defined by each state	$86.25	• Use modifier U2 to identify subacute level of care

Note:

Procedure Type “N” is for Medicine type codes; Procedure Type “P” is for Podiatry type codes. If the National Code rate differs from the Interim Code rate, the National Code rate will be applied.

Effective for dates of service on or after March 1, 2011, the Department of Health Care Services (DHCS) will discontinue the use of current local modifiers ZA, ZB, ZC, ZD, ZE, ZF, ZG, ZH, ZI, ZJ, ZO, ZP, ZR, ZT, ZX and ZY used with anesthesia services. These local modifiers will be replaced by HIPAA compliant HCPCS modifiers to comply with the provisions of HIPAA of 1996, Public Law 104-191, Code of Federal Regulations, Title 45, Section 162.1000.

The following changes are effective March 1, 2011:

Medi-Cal Modifier	Modifier Description	Proposed National Modifier(s)
ZA	Anesthesia procedures complicated by unusual position or surgical field avoidance	22 – Increased procedural services
ZB	Anesthesia (emergency services, healthy patient)	P1 – A normal healthy patient and ET – Emergency services
ZC	Anesthesia complicated by extracorporeal circulation	P4 – A patient with severe systemic disease that is a constant threat to life Note: Use ICD-9-CM diagnosis code 998.89 (other specified complications of procedures, not otherwise classified) to indicate extracorporeal circulation.
ZD	Emergency anesthesia (systemic disease)	P4 – A patient with severe systemic disease that is a constant threat to life and ET – Emergency services
ZE	Nurse anesthetist service; elective anesthesia:  normal, healthy patient	P1 – A normal healthy patient and QX – CRNA service: with medical direction by a physician
ZF	Anesthesia supervision	QK – Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals Note: Modifier QK will also be used when billing for the supervision of one anesthesia procedure.
ZG	Multiple anesthesia modifiers	99 – Multiple modifiers
ZH	Nurse anesthetist service; anesthesia special circumstances:  unusual position/field avoidance	22 – Increased procedural services and QX – CRNA service: with medical direction by a physician
ZI	Nurse anesthetist service; anesthesia special circumstances:  total body hypothermia	P4 – A patient with severe systemic disease that is a constant threat to life and QX – CRNA service: with medical direction by a physician Note: Use ICD-9-CM code 995.89 (other specified adverse effects, not elsewhere classified) when billing for total body hypothermia.
ZJ	Nurse anesthetist service; emergency anesthesia: normal, healthy patient	P1 – A normal healthy patient and QX – CRNA service: with medical direction by a physician and ET – Emergency services
ZO	Nurse anesthetist service; anesthesia special circumstances:  extracorporeal circulation	P4 – A patient with severe systemic disease that is a constant threat to life and QX – CRNA service: with medical direction by a physician Note: Use ICD-9-CM diagnosis code 998.89 (other specified complications of procedures, not elsewhere classified) to indicate extracorporeal circulation.
ZP	Nurse anesthetist service; elective anesthesia:  patient with severe systemic disease that is a constant threat to life	P4 – A patient with severe systemic disease that is a constant threat to life and QX – CRNA service: with medical direction by a physician
ZR	Nurse anesthetist service; emergency anesthesia:  patient with severe systemic disease that is a constant threat to life	P4 – A patient with severe systemic disease that is a constant threat to life and QX – CRNA service: with medical direction by a physician and ET – Emergency services
ZT	Nurse anesthetist service; emergency anesthesia:  moribund patient who is not expected to survive without the operation	P5 – A moribund patient who is not expected to survive without the operation and QX – CRNA service: with medical direction by a physician and ET – Emergency services
ZX	Nurse anesthetist service; emergency or elective anesthesia:  patient with severe systemic disease	P3 – A patient with severe systemic disease and QX – CRNA service: with medical direction by a physician and ET – Emergency services
ZY	Nurse anesthetist service; elective anesthesia:  moribund patient who is not expected to survive without the operation	P5 – A moribund patient who is not expected to survive without the operation and QX – CRNA service: with medical direction by a physician

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 Clinics and Hospitals Durable Medical Equipment and Medical Supplies Expanded Access to Primary Care Program General Medicine Home Health Agencies/Home and Community-Based Services Local Educational Agency Medical Transportation Obstetrics Orthotics and Prosthetics Rehabilitation Clinics Therapies Vision Care	modif app (7, 11–13, 15–16)
General Medicine Obstetrics Clinics and Hospitals	anest (6–8, 17–24)
General Medicine Obstetrics	anest cms (4–7)
Clinics and Hospitals	anest ub (6–7)

The code conversion of interim billing codes for Comprehensive Perinatal Services Program (CPSP) services will not be implemented on April 1, 2011, as stated in previous Medi-Cal Updates. Providers should continue billing for CPSP services according to the existing instructions in the Medi-Cal provider manual until further notice.

Effective for dates of service on or after April 1, 2011, the Department of Health Care Services (DHCS) will discontinue the use of current Medi-Cal interim code Z0336 for medical abortion services. This interim code will be replaced by HIPAA compliant HCPCS to comply with the provisions of HIPAA of 1996, Public Law 104-191, Code of FederalRegulations, Title 45, Part 162.1000.

Providers must not bill the new coding standards until they are instructed to do so in future Medi-Cal Updates.

The following change is effective April 1, 2011:

Interim Code	Interim Code Description	Interim Code Rate	Proposed National Code/Modifier	National Code Rate
Z0336	Medical Abortion	$383.10	HCPCS Code S0199 – Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by HCG, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion ) except drugs	$383.10

The Centers for Disease Control and Prevention (CDC) 2010 influenza vaccine recommendations include the following:

1. Routine influenza vaccination is recommended for all persons aged 6 months and older, if not medically contraindicated.
2. As in previous recommendations, all children aged 6 months through 8 years who receive a seasonal influenza vaccine for the first time should receive two doses. Children who received only one dose of a seasonal influenza vaccine in the first influenza season that they received vaccine should receive two doses, rather than one, in the following influenza season. In addition, for the 2010-2011 influenza season, children aged 6 months through 8 years who did not receive at least one dose of an influenza A (H1N1) 2009 monovalent vaccine should receive two doses of a 2010-2011 seasonal influenza vaccine, regardless of previous influenza vaccination history. Children aged 6 months through 8 years for whom the previous 2009-2010 seasonal or influenza A (H1N1) 2009 monovalent vaccine history cannot be determined should receive two doses of a 2010-2011 seasonal influenza vaccine. Minimal interval between two doses is four weeks.

For more information about influenza vaccination recommendations, providers can review the Morbidity and Mortality Weekly Report (MMWR): Prevention and Control of Influenza with Vaccines on the CDC website.

Medi-Cal providers seeking enrollment in the Family PACT (Planning, Access, Care and Treatment) Program are required to attend a Provider Orientation and Update Session. Dates for upcoming sessions are listed below. Registration opens at 8 a.m., with Session I beginning promptly at 8:30 a.m.

Individual and group providers wishing to enroll must send a physician-owner to the session. Non-profit and government clinics seeking to enroll must send their medical director, physician or nurse practitioner who is responsible for oversight of medical services rendered at the service site where the provider wants to enroll.

Office staff members, such as clinic managers, billing supervisors and client eligibility enrollment supervisors, are encouraged to attend. However, these staff members are not eligible to receive a Certificate of Attendance. Enrolled clinicians and staff are encouraged to attend to remain current with program policies and services.

Session Format
Family PACT has created a new session format, which offers an option for currently enrolled providers and staff to attend only the afternoon update session, along with either the clinical session or the billing and coding session.

Session I – Overview of the Family PACT Program:

Start Time	8:30 a.m. to 2 p.m.
Instructions	Attendance at this presentation is mandatory for clinician providers wishing to enroll in Family PACT and is recommended for other staff who are new to the program or need a refresher.

Note:  The afternoon sessions will run concurrently from 2 p.m. to 4 p.m.

Session II – Clinical Practice Alerts:

Start Time

2 p.m. to 4 p.m.

Instructions

Clinicians in attendance who wish to become Family PACT providers must also attend this session. Free continuing education (CE) credit is available for Session II. Providers must bring their medical license number if requesting CE credit; a continuing education request form will be available during onsite registration. Other interested clinical staff are welcome to attend and may request free CE credit for this session.

Session III – Tips for Successful Family PACT Administration:

Start Time	2 p.m. to 4 p.m.
Instructions	Administrators and billers interested in Family PACT Program administration and billing information may attend.

Please note the upcoming Provider Orientation and Update Sessions below.

Santa Barbara February 17, 2011 8:30 a.m. – 4 p.m. Hotel Mar Monte 1111 East Cabrillo Boulevard Santa Barbara, CA 93103 (805) 963-0744

Ontario May 12, 2011 8:30 a.m. – 4 p.m. Hilton Ontario Airport 700 North Haven Avenue Ontario, CA 91764 (909) 980-0400

Mendocino June 9, 2011 8:30 a.m. – 4 p.m. The Stanford Inn 44855 Comptche Ukiah Road Mendocino, CA 95460 1-800-331-8884

For a map and directions to these locations, providers can go to the Family PACT website and click “Directions and Map of Location” for the appropriate session location.

Registration
To register for an orientation and update session, providers should:

• Go to the Family PACT website and click the “Registration” link next to the appropriate date and location.
• Print a copy of the registration form.
• Identify desired session(s).
• Fill out the form and fax it to the Office of Family Planning, ATTN: Darleen Kinner at (916) 650-0468.

Providers with no Internet access may request the registration form by calling 1-877-FAMPACT (1-877-326-7228). Providers must supply the following when registering:

• Name of the Medi-Cal provider or facility
• National Provider Identifier (NPI)
• Contact telephone number
• Anticipated number of people attending

Check-In
Check-in begins at 8 a.m. All orientation sessions start promptly at 8:30 a.m. and end by 4 p.m. At the session, providers must present the following:

• NPI
• Medical license number
• Photo identification

Note:  Individuals representing a clinic or physician group should use the clinic or group NPI, not an individual NPI or license number.

Certificate of Attendance
Upon completion of the orientation session, each prospective new Family PACT medical provider will receive a Certificate of Attendance. Providers should include the original copy of the Certificate of Attendance when submitting the Family PACT application and agreement forms (available at the session) to Family PACT Provider Enrollment. Providers arriving late or leaving early will not receive a Certificate of Attendance. Currently enrolled Family PACT providers do not receive a certificate.

Contact Information
For more information about the Family PACT Program, please call 1-877-FAMPACT (1-877-326-7228) or visit the Family PACT website.

The Family PACT Program was established in January 1997 to expand access to comprehensive family planning services for low-income California residents.

Effective for dates of service on or after April 1, 2011, new Medi-Cal benefit HCPCS code J7184 ( injection, von Willebrand factor complex [human], Wilate, per 100 iu vwf:rco) will be payable in conjunction with ICD-9-CM code 286.4 (von Willebrand’s disease).

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

Provider Manual(s)	Page(s) Updated
General Medicine Outpatient Clinics and Hospitals Chronic Dialysis Clinics Pharmacy	blood (2)

Effective for dates of service on or after March 1, 2011, local HCPCS codes X6432 (Kenalog-10) and X6976 (Triamcinolone Diacetate – 25 mg/ml suspension) will be terminated.

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 (10, 18)

The Cancer Detection Programs: Every Woman Counts Covered Procedures documents were revised in January. The revised documents are available on the CDP: Every Woman Counts page.

Changes include revised covered procedures language, the use of ICD-9-CM codes specific to the CDP: EWC program required for reimbursement and the addition of CPT-4 code 99359 to the Breast Only Covered Procedures and Breast & Cervical Covered Procedures forms.

The following provider manual sections have been updated: Contract Drug List Part 1 – Prescription Drugs and Drugs: Contract Drugs List Part 4 – Therapeutic Classifications Drugs.

Drug			Strength and/or Size		Billing Unit
Addition, effective November 16, 2010
‡ ERIBULIN MESYLATE
		Injection	0.5 mg/ml		ml
Additions, effective February 1, 2011
MILNACIPRAN HCL
		Tablets	12.5 mg		ea
			25 mg		ea
			50 mg		ea
			100 mg		ea
		Titration Pack
		Tablets	12.5 mg	contains 5 tablets	ea
			25 mg	contains 8 tablets	ea
			50 mg	contains 42 tablets	ea
SAXAGLIPTIN/METFORMIN HCL EXTENDED RELEASE
		Tablets	2.5/1000 mg		ea
			5 mg/500 mg		ea
			5 mg/1000 mg		ea
Change, effective February 1, 2011
* NIACIN AND SIMVASTATIN
	*	Restricted to NDC labeler code 00074 (Abbott Laboratories) only
		Tablets (containing extended release niacin)
			500 mg/20 mg		ea
			500 mg/40 mg		ea
			750 mg/20 mg		ea
			1000 mg/20 mg		ea
			1000 mg/40 mg		ea

‡    Drug is exempt from the monthly drug claim line limit.

As implementation moves forward for the International Classification of Diseases, 10th Revision (ICD-10), providers should consider not only the impact on business processes and policies, but how it is intertwined with other health reform initiatives. In addition to the update of HIPAA standards such as the ICD-10 and the Transactions and Code Sets Version 5010, the federal government approved both the Health Information Technology for Economic and Clinical Health Act (HITECH Act), and the Patient Protection and Affordable Care Act (PPACA) demonstrating the commitment to “build a healthier future for our nation” by modernizing the U.S. health care system in order to improve efficiency, quality, and access to health care.

The common thread in these initiatives is the ICD-10. The transition to ICD-10 will facilitate the widespread adoption of more efficient and cost effective health information technology (HIT). ICD-10 offers greater specificity and detail that provides the ability to more precisely code diagnoses and procedures. ICD-10 reflects advances in medicine and medical technology, making the code sets more relevant to today’s understanding of disease processes. In addition, ICD-10 standardizes terminology used throughout the health care continuum, making it consistent with national and international public health data reporting. It is a critical element in Electronic Health Record (EHR) interoperability and the electronic exchange of data.

In 2009, the HITECH Act was passed as part of the American Recovery and Reinvestment Act (ARRA). It authorizes the Centers for Medicare & Medicaid Services (CMS) to provide reimbursement incentives to eligible providers who demonstrate “meaningful use” of EHR. U.S. Health and Human Services (HHS) directed the Office of National Coordinator for Health Information Technology (ONC) to maintain and furnish information specific to this provision. In July 2010, the Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule was issued to further define “meaningful use” criteria and supply guidelines for providers to qualify for financial incentives. These incentives for adoption of EHR are set to phase out in 2015 when penalties for non-compliance are set to begin. Although ICD-10 is not currently a requirement of the meaningful use provision in the HITECH Act, they are likely to merge at some point, especially with regard to vendor certification of EHR technology.

President Obama signed the PPACA into law in March 2010. Commonly referred to as the Health Reform Law, the provisions of the PPACA enhance the broad objectives of the ARRA and HITECH Act to modernize health care and improve overall efficiency, safety and quality. The Health Reform Law requires most Americans to carry health insurance and provides subsidies for people with low to middle incomes to help in the purchase of private coverage. It also regulates private insurers more closely and includes numerous provisions designed to modernize Medicare and Medicaid programs to make them more cost-efficient. Although ICD-10 is not named in the PPACA, it will play a large role through payment demonstration projects, disease management, as well as fraud and abuse detection and prevention.

The health care industry is in the midst of a major transformation. It is estimated that health care reform will change more than 90 percent of the payer’s IT architecture. Providers are realizing that these reforms and mandates are not just IT projects, as the initiatives require major changes in the way they provide care. The mandates issued by the federal government are not independent of one another, but designed to be complimentary in improving the health care system while counteracting skyrocketing costs. ICD-10 is at the core of these reforms because it provides the standardized, high quality data necessary for the future of the system.

Reports show that most vendors are falling behind with the upgrade to HIPAA Transactions and Code Sets Version 5010, a required component for the adoption of ICD-10. Medi-Cal providers are encouraged to start working towards the October 1, 2013, transition deadline by taking advantage of the multiple incentives and resources currently available to implement changes early in the process. Providers should also work closely with software vendors and assist staff with training.

As daunting as the task may seem, a successful transition to ICD-10 will allow providers to embrace the changing health care industry and not get left behind.

For more information providers may visit:

• Office of National Coordinator for Health Information Technology at the ONC website
• Provider Resources for the ICD-10 at the CMS website.
• General information at the WEDI website.

Effective retroactively for dates of service on or after March 1, 2008, the maximum dosage for HCPCS code J2278 (injection, ziconotide, 1 microgram) is adjusted to 500 mcg, and is reimbursable at $11.75 per unit. Providers submitting claims with the UB-04 claim form are also reminded that multiple claim lines may be necessary since entries are limited to two digits per line.

An Erroneous Payment Correction (EPC) will be issued to providers whose claims were erroneously denied. Providers do not need to re-bill; claims will be automatically reprocessed.

Providers are reminded that an ultrasound performed prior to an induced abortion is reimbursable with CPT-4 codes 76801 – 76812, 76815 and 76817 when billed in conjunction with ICD-9-CM diagnosis code V61.7.

CPT-4 codes 76813 (ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation) and 7 6814 (each additional gestation [list separately in addition to code for primary procedure]) are not reimbursable when performed prior to an induced abortion.

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

Provider Manual(s)	Page(s) Updated
Clinics and Hospitals General Medicine Obstetrics	abort (3)

The following codes will be added/end-dated to/from the California Children’s Services (CCS) Service Code Groupings (SCGs):

Added Code(s)

Effective Date	Code	SCGs
February 1, 2011	HCPCS code J1610	01, 02, 03, 07 and 12
February 1, 2011	HCPCS codes J 0150, J0152 and J9395	01, 02, 03 and 07

End-Dated Code(s)

Effective Date	Code	SCGs
February 1, 2011	HCPCS codes X6252 and X6254	01, 02, 03, 07 and 12
February 1, 2011	HCPCS codes X5522, X6976 and X7654	01, 02, 03 and 07

Reminder:

SCG 02 includes all the codes in SCG 01, plus additional codes applicable only to SCG 02. SCG 03 includes all the codes in SCG 01 and SCG 02, plus additional codes applicable only to SCG 03. SCG 07 includes all the codes in SCG 01 plus additional codes applicable only to SCG 07.

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

Provider Manual(s)	Page(s) Updated
Audiology and Hearing Aids Durable Medical Equipment and Medical Supplies Medical Transportation Orthotics and Prosthetics Psychological Services Therapies Inpatient Services Clinics and Hospitals Chronic Dialysis Clinics Home Health Agencies/Home and Community-Based Services Local Educational Agency Rehabilitation Clinics General Medicine Obstetrics Pharmacy Vision Care	cal child ser (1–4, 24)

Effective for dates of service on or after March 1, 2011, the following local HCPCS codes will be end-dated and converted to national HCPCS code J0690 (injection, cefazolin sodium, 500 mg):

Code	Description
X5602	Cefazolin Sodium – 10 gm/100 ml vial
X5604	Cefazolin Sodium – 1 gm/redi vial
X5606	Cefazolin Sodium –1 gm/100 ml piggyback unit
X5608	Cefazolin Sodium – 1 gm/10 ml vial
X5610	Cefazolin Sodium – 500 mg/100 ml vial
X5612	Cefazolin Sodium – 500 mg/10 ml vial
X5614	Cefazolin Sodium – 250 mg/10 ml vial

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 (2, 4, 10)

Effective for dates of service on or after March 1, 2011, HCPCS code C9256 (dexamethasone intravitreal implant 0.1 mg) will be converted to HCPCS code J7312.

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

Provider Manual(s)	Page(s) Updated
Clinics and Hospitals General Medicine	hcpcs ii (3–4); inject drug a-l (14); ophthal (12); ophthal cd (1)
Chronic Dialysis Clinics Obstetrics	hcpcs ii (3–4); inject drug a-l (14)
Pharmacy Rehabilitation Clinics	inject drug a-l (14)

Effective for dates of service on or after March 1, 2011, HCPCS code J0220 (Lumizyme 10 mg) will be converted to C9277 (Lumizyme 1 mg) for billing alglucosidase alfa. Myozyme is still reimbursable with HCPCS code J0220 when used for treatments to recipients younger than 8 years of age with infantile onset Pompe disease.

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 (5); inject drug a-l (18)

Effective for dates of service on or after January 1, 2011, providers must use HCPCS code J3385 (injection, velaglucerase alfa, 100 units), instead of HCPCS code J3590 (unclassified biologicals) to bill for velaglucerase alfa. Velaglucerase alfa is indicated for use in patients 4 years of age or older with a rare genetic disorder called Type I Gaucher disease. A Treatment Authorization Request (TAR) is required that must include a diagnosis of Type I Gaucher disease. The recommended dosage is 60 units/kg every other week as a 60-minute infusion.

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

Provider Manual(s)	Page(s) Updated
General Medicine Obstetrics Clinics and Hospitals Chronic Dialysis Clinics Rehabilitation Clinics Pharmacy	inject cd list (18); inject drug a-l (22)

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

Addition, effective January 1, 2011
NDC Labeler Code	Contracting Company’s Name
64950	LEHIGH VALLEY TECHNOLOGIES, INC.
Additions, effective April 1, 2011
NDC Labeler Code	Contracting Company’s Name
45945	CNS THERAPEUTICS INC.
52276	ORPHAN EUROPE, SARL
Terminations, effective January 1, 2011
NDC Labeler Code	Contracting Company’s Name
50484	SMITH & NEPHEW, INC.
52735	FAMILY PHARMACY-AMERISOURCE/BERGEN
64406	IDEC PHARMACEUTICALS CORPORATION
65199	VATRING PHARMACEUTICALS, INC.
66794	RX HOLDINGS, LLC (RXELITE)
66860	CURA PHARMACEUTICAL CO. INC.
Terminations, effective April 1, 2011
NDC Labeler Code	Contracting Company’s Name
13632	ROSEMONT PHARMACEUTICALS, LTD
42826	SIRION THERAPEUTICS, INC.
55654	TRI-MED LABORATORIES, 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 Rehabilitation Clinics	drugs cdl p5 (6, 8–11,13–15)

Effective March 28, 2011, claims processed with dates of service retroactive to October 1, 2010, will have National Correct Coding Initiative (NCCI) edits applied. Providers are encouraged to visit the Centers for Medicare & Medicaid Services (CMS) NCCI Edits Overview page to learn more about this nationally mandated program that will affect the way Medi-Cal processes claims. Implementation of NCCI may result in reduced provider payments because NCCI edits are designed to prevent inappropriate reimbursement of services including, but not limited to services that are:

• Mutually exclusive
• Inappropriately bundled (a comprehensive service billed with a component service)
• Billed with too many units of service (medically unlikely)

The Medi-Cal claims processing system already reviews claims for many of the preceding. However, it is expected the NCCI edits will further impact claim payment.

Claims Already Submitted
Claims with dates of service on or after October 1, 2010, which were processed prior to the implementation of NCCI on March 28, 2011, will not be reprocessed to enforce NCCI edits; however, claims processed or reprocessed on or after March 28, 2011, with dates of service on or after October 1, 2010, will be subject to NCCI claim edits.

NCCI
NCCI is a federally mandated program. CMS developed NCCI to promote coding methods that prevent inappropriate claim payments. In addition to standard Medi-Cal claims processing edits, provider claims will be reviewed for NCCI’s two edit types:

• Procedure-to-procedure (column 1/column 2) edits: These edits define pairs of HCPCS and CPT-4 codes that should not be reported together. The purpose of these edits is to ensure the most comprehensive groups of codes are billed, rather than the component parts. Additionally this edit checks for mutually exclusive code pairs.
• Medically Unlikely Edits (MUEs): These edits compare the units of service billed on the claim against maximum limits set by CMS for each HCPCS or CPT-4 code. For example, a provider will not be reimbursed for removing more than one complete gall bladder or one appendix.

NCCI Column 1/Column 2
CMS developed its coding policies based on coding conventions defined in the American Medical Association’s CPT manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The results of that analysis helped define the CMS editing tables, which are being incorporated into Medi-Cal’s claim review process.

Column 1		Column 2		Modifier 0=Not Allowed 1=Allowed 9=Not Applicable
12001		64450		0
12001		G0168		1
12001		93010		1

The column 1/column 2 correct coding edit table contains two types of code pair edits, as follows:

Comprehensive : The code in column 1, which usually represents the more significant (comprehensive) procedure, is compared to the code in column 2, which is considered a subpart (component) of the service in column 1. Claims submitted for reimbursement of both codes without justification will be denied because the service represented by the code in column 1 includes the service represented by the code in column 2.

Mutually Exclusive : The code in column 1 is compared to the code in column 2. The claim is denied because it is medically unlikely that both services would be rendered to the same recipient, by the same provider on the same date of service (for example, a hysterectomy and vasectomy).

The column 1/column 2 table has an additional function, to allow the use of NCCI-approved modifiers. Providers use the modifier to show their claim is an exception to usual practices and should be reimbursed. For example, a physician performing two significant, separately identifiable Evaluation & Management (E&M) services for twins using the same Medi-Cal identification number in the first 60 days of life might enter modifier 25 on the claim and provide documentation showing why the two E&M procedures were medically necessary.

Modifiers
CMS has identified a set of modifiers to facilitate NCCI claims processing. For claims where multiple encounters or other circumstances could appear to fail NCCI edits and lead to inappropriate claim denial, providers may use the following modifiers to accurately define the service encounter. (An asterisk indicates the modifier has not been previously used by Medi-Cal but will be added to the list of approved modifiers.):

Modifier	Description (see code book for full description)
Anatomical Modifiers
E1 – E4	Anatomic areas of the eye lid
F1 – F9, * FA *	Hands and digits
LC, * LD, * RC *	Anatomic areas of the coronary arteries
LT, RT	Left and right sides of the body
T1 – T9, * TA *	Foot and toes
Global Surgery Modifiers
25	Separate Evaluation & Management (E&M) on the same day
58	Staged or related procedure by same physician during postop period
78	Unplanned return to the operating/procedure room
79	Unrelated procedure or service during postop period
Other Modifiers
59	Distinct procedural service
91 *	Repeat clinical diagnostic laboratory test

Modifiers on claim: Medi-Cal allows up to four modifiers on a single claim line for both the CMS-1500 and UB-04 claim forms. These are the claim types affected by NCCI. The NCCI-recognized modifier must be billed in one of the four modifier positions. Multiple NCCI modifiers cannot be included on the same claim line.

Modifiers on Treatment Authorization Requests (TARs): Providers are reminded that when modifiers are required on a TAR, the TAR must reflect the same modifier use as the claim. Therefore, effective immediately, multiple NCCI-recognized modifiers must not be included on a single TAR line, including modifiers LT and RT. The claims processing system and Medi-Cal provider manual will be updated to reflect this instruction.

In order for a provider to assign the correct modifier and bypass an NCCI edit, it is important that the biller understands and meets the conditions of that modifier. All claims are subject to post-payment review.

Services Affected
NCCI procedure to procedure and MUE edits will not be applied to every Medi-Cal service and claim. Only claims for the following services will be subject to NCCI edits:

• Practitioner services
• Ambulatory surgical center services
• Outpatient hospital services
• Supplier claims for Durable Medical Equipment

Claims Processing
In the Medi-Cal processing system, claims will process for NCCI edits before being processed for Medi-Cal edits. NCCI procedure to procedure edits and MUE limits are applied to services performed by the same provider for the same recipient on the same date of service. A TAR or medical justification submitted with the claim may be allowed to override an NCCI Medically Unlikely Edit. That is, where medical justification is currently allowed to override a Medi-Cal edit, this justification may be considered for a quantity greater than that allowed by the MUE. NCCI procedure to procedure edits are applied to all services with the same date of service whether the services are submitted on the same or different claims. MUE limits are applied separately to each line of a claim.

ZIP (compressed) files showing NCCI edits are available on the CMS website. Additionally, charts showing NCCI-related edits, including MUEs and column 1/column 2 edits for HCPCS Level II codes, are included in the back of the 2011 HCPCS code book.

Claim Denial and Appeal
There is no claim processing system automatic override for NCCI edits. Claims that fail the NCCI edits will be denied and returned to the provider. If the denial was based on an MUE value, the provider may submit an Appeal for reconsideration of payment in excess of the normally allowed amount. Claims Inquiry Forms (CIFs) will not be accepted for claims denied as a result of NCCI edits.

Additional Information and Training
Providers may refer to the downloadable National Correct Coding Initiative Policy Manual for Medicaid Services for supplemental NCCI information. Additionally, information will be available from:

• Medi-Cal NCCI website
• Future webinars
• Future Medi-Cal Update bulletins
• New NCCI-focused Medi-Cal provider manual section
• Telephone Service Center at 1-800-541-5555