After November 2019, Child Health and Disability Prevention (CHDP) program information is incorporated into several Medi-Cal provider manuals, including the General Medicine and Clinics and Hospitals manuals.

CHDP Manual Discontinued
The CHDP Provider Manual primarily contained instructions for billing non-HIPAA compliant local codes on the Confidential Screening/Billing Report (PM 160) claim form. This information is outdated and is discontinued.

New EPSDT/CHDP Provider Manual Sections
CHDP program information may now be found in three new EPSDT/CHDP provider manual sections, as follows:

Title	Content
EPSDT/CHDP	Most of the CHDP policy moved from the obsolete CHDP Provider Manual is captured in this section, including information about: CHDP program background, provider enrollment, provider responsibilities, recipient eligibility, components of health assessments and immunizations. There is some billing instruction but most of the billing is according to standard Medi-Cal practices as explained in the provider manual billing sections. The Part 2 Medi-Cal manual section, Child Health and Disability Prevention (CHDP) Program, is discontinued, with select information incorporated into this new EPSDT/CHDP section.
EPSDT/CHDP: Gateway	This section contains information from the former Gateway and Gateway Transactions Overview sections.
EPSDT/CHDP: School-Based Services	Primarily carried over from CHDP Provider Manual section, CHDP Transition to National Standards: School-Based Services.

The three EPSDT/CHDP sections do not contain new policy.

Note:

Providers were notified in a previous NewsFlash titled “Transition of CHDP Information to EPSDT/CHDP Sections” that providers wishing to retain CHDP Provider Manual content for future research should save the manual sections to their own computers. After November 30, 2019, there is no assurance the former CHDP Provider Manual sections will be available on the Medi-Cal website.

CHDP More Closely Aligned with EPSDT Section in Medi-Cal Manual
In California, CHDP administers the Early and Periodic screening components of the federally mandated Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for individuals under the age of 21. The CHDP program information is now aligned with the EPSDT section of the Medi-Cal provider manual under EPSDT/CHDP.

Finding EPSDT/CHDP Information
The EPSDT/CHDP sections will publish in the following Part 2, Medi-Cal provider manuals. Additionally, EPSDT/CHDP articles will publish in the monthly bulletin that corresponds to each of the following manuals:

• Obstetrics


• General Medicine


• Clinics and Hospitals


• Audiology and Hearing Aids


• Orthotics and Prosthetics


• Psychological Services


• Vision Care

Exception:

The EPSDT/CHDP: School-Based Services provider manual section publishes only in the General Medicine and Clinics and Hospitals manuals. Corresponding articles will publish only in the General Medicine and Clinics and Hospitals monthly bulletins. Providers are encouraged to subscribe for Medi-Cal Subscription Service (MCSS) notification for one or both of these manuals to obtain all CHDP program information.

CHDP Updates Continue
The Department of Health Care Services (DHCS) is working diligently to update CHDP information in provider manuals and on both the Medi-Cal and DHCS websites. Because both the DHCS and Medi-Cal websites have or will undergo reorganization, updating efforts will continue for some time.

Providers are encouraged to watch for EPSDT/CHDP updates in the NewsFlash area on the Medi-Cal website and subscribe to MCSS to receive timely notifications related to CHDP by completing the MCSS Subscriber Form.

CHDP Gateway Internet User Guide
Recent updates were made to the CHDP Gateway Internet Step-by-Step User Guide unrelated to this process. Providers are encouraged to review the guide for current information regarding CHDP Gateway transactions.

Questions
Providers with questions may call the Telephone Service Center (TSC) at 1-800-541-5555 from 8 a.m. to 5 p.m., Monday through Friday, except holidays.

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

Provider Manual(s)	Page(s) Updated
Part 1	check (1); cmc enroll (1–7, 12); elect (1); prog (4); prov guide (11)
Acupuncture Chiropractic	cms comp (21)
Audiology and Hearing Aids Obstetrics Orthotics and Prosthetics	cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13)
Chronic Dialysis Clinics Home Health Agencies/Home and Community-Based Services Inpatient Services Local Educational Agency Rehabilitation Clinics	cal child bil guide (1)
Clinics and Hospitals	cal child bil guide (1); epsdt chdp (1–31); epsdt chdp gate (1–13); epsdt chdp school (1–6); spec (6)
Durable Medical Equipment Medical Transportation Pharmacy Therapies	cal child bil guide (1); cms comp (21)
General Medicine	cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13); epsdt chdp school (1–6); spec (6)
Psychological Services	cal child bil guide (1); cms comp (21); epsdt chdp (1–31); epsdt chdp gate (1–13); spec (6)
Vision Care	cal child bil guide (1); cms comp vc (11); epsdt chdp (1–31); epsdt chdp gate (1–13); pia (1); rates max eye app (2)

Update: Replacement Durable Medical Equipment (DME) and Medical Supplies for Recipients Impacted by Fires and Extreme Weather Conditions or Public Safety Power Shutoff

On October 28, 2019, in response to the Governor’s recent proclamation of a statewide state of emergency due to the risk of wildfires, the Department of Health Care Services (DHCS) issued guidance for dispensing replacement medication(s) to recipients impacted by fires and extreme fire weather conditions or public safety power shutoff. This article provides additional guidance for dispensing DME and medical supplies.

Providers are instructed to incorporate the statement “Patient impacted by fires and extreme fire weather conditions or public safety power shutoff.” within the Miscellaneous Information field on the Treatment Authorization Requests (TAR) for DME, medical supplies or situations requiring a TAR.

DME and medical supply providers must provide requested equipment or supplies immediately or, for items not in stock, as soon as possible, if the need to dispense DME or medical supplies is related to the recipient’s displacement or subjection to fires and extreme fire weather conditions or public safety power shutoff. Providers must not have the recipient return after receiving TAR approval. The need for a TAR should not negatively affect the decision to provide DME or medical supplies immediately or as soon as possible, and the TAR can be submitted retroactively. It is imperative that the impacted recipient receive the DME or medical supply in a timely manner to facilitate compliance and assist the recipient to perform activities of daily living.

TARs for new or replacement DME or medical supplies will be automatically approved if the TAR indicates that the recipient is impacted by fire or by power shutoffs, and the provider will be paid for the claim for the DME or medical supply. The negative impact of the fire or power shutoff, alone, will meet the criteria of medical necessity.

Providers are encouraged to monitor the Medi-Cal website for future updates. Questions regarding this notice may be directed to the Telephone Service Center (TSC) at 1-800-541-5555, Monday through Friday, except holidays.

Effective for dates of service on or after December 1, 2019, CPT code 76800 (ultrasound, spinal canal and contents) is reimbursable when billed in conjunction with ICD-10-CM diagnosis code Q82.6 (congenital sacral dimple).

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

Provider Manual(s)	Page(s) Updated
Clinics and Hospitals General Medicine Obstetrics	radi dia ult (2)

Effective for dates of service on or after May 1, 2019, HCPCS code A4268 (contraceptive supply, condom, female, each) may be billed separately at the rate of $2.50 per unit for the Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs. The clinic dispensing fee is 10 percent of the subtotal billed. In addition, the dispensing limit for code A4268 is up to 12 units per claim and up to 24 units in a 90-day period.

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

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

Provider Manual(s)	Page(s) Updated
Clinics and Hospitals General Medicine Obstetrics	fam planning (5, 13, 14)
Family PACT	ben grid (24); clinic (4, 8, 10); drug (3, 5); drug onsite (1)

Effective for dates of service on or after February 1, 2020, the following medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes: HCPCS codes A4222, A4230 – A4232, A4483, A7002 – A7004, A7006 – A7008, A7010, A7012, A7013, A7016, B4035 and S8186. Note that codes A4230 – A4232 and A7008 are not benefits.

These HCPCS codes that describe items used in the operation of DME will no longer be medical supply codes on the List of Medical Supplies Billing Codes, Units and Quantity Limits. These HCPCS codes must be billed as DME supply codes.

Updates to Medical Supply Codes
Effective for dates of service on or after February 1, 2020, medical supply HCPCS codes are updated as follows:

A4223	Infusion supplies not used with external infusion pump, per cassette or bag. Use to bill all necessary supplies that are not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to administrative sets and syringes, tubing, extension tubing, connecting devices and port caps) for the administration, without a pump, of non-insulin drugs. Bill one (1) quantity unit per each administrative/infusion set/kit or per each separate item (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 30 units per 27-day period require authorization. Documentation of product cost (an invoice, manufacturer’s catalog page or price list) is required as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement. Refer to DME supply HCPCS code A4222 for infusion supplies used with an external infusion pump.
B4034	Enteral feeding supplies; syringe fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by syringe and maintain the feeding site.
B4036	Enteral feeding supplies; gravity fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by gravity and maintain the feeding site. For claims using HCPCS code B4034 and B4036, bill one (1) quantity unit per each administrative/supply set/kit or per each separate item, (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 31 units per 27-day period require authorization. HCPCS code B4034 and B4036 require documentation of product cost (an invoice, manufacturer’s catalog page or price list) as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement. Note: HCPCS code B4035, enteral feeding supplies (pump fed), is updated to a DME supply code.

Effective for dates of service on or after February 1, 2020, HCPCS codes B9998, B9999 and S1015 will be end-dated. Providers must bill the items using the following codes:

• For extension tubing and sets for enteral feeding, bill using HCPCS code B4034, B4035 or B4036, depending on the route of administration.


• For infusion supplies including extension tubing and IV extension sets, bill using the appropriate HCPCS code depending on use with or without an external infusion pump.

Updates to DME Supply Codes
HCPCS codes A4230 – A4232 and A7008 are no longer benefits. The table below specifies policy for new DME supply codes A4483, A7002 – A7004, A7006, A7007, A7010, A7012, A7013, A7016, B4035 and S8186. In addition, policy for codes A4222, A4224, A4225 and E0574 is as follows.

HCPCS Code	Description	Taxable/Non-Taxable	Frequency Limit, Any Provider
A4222 * +	Infusion supplies for external drug infusion pump, per cassette or bag	Non-taxable	--
A4224 * + ^	Supplies for maintenance of insulin infusion catheter, per week	Non-taxable	1 per week
A4225 * + ^	Supplies for external insulin infusion pump, syringe type cartridge, sterile, each	Non-taxable	15 per month
A4483 * + ^	Moisture exchanger, disposable, for use with invasive mechanical ventilation	Non-taxable (no change)	31 per month
A7002 * +	Tubing, used with suction pump, each	Non-taxable	4 per month
A7003 * +	Administration set, with small volume nonfiltered pneumatic nebulizer, disposable	Taxable (no change)	2 per month
A7004 * +	Small volume nonfiltered pneumatic nebulizer, disposable	Taxable (no change)	2 per month
A7006 * +	Administration set, with small volume filtered pneumatic nebulizer	Taxable (no change)	1 per month
A7007 * +	Large volume nebulizer, disposable, unfilled, used with aerosol compressor	Taxable (no change)	1 in 2 months
A7010 * +	Corrugated tubing, disposable, used with large volume nebulizer, 100 ft	Taxable (no change)	1 in 2 months
A7012 * +	Water collection device, used with large volume nebulizer	Taxable (no change)	2 per month
A7013 * +	Filter, disposable, used with aerosol compressor or ultrasonic generator	Taxable (no change)	2 per month
A7016 * +	Dome and mouthpiece, used with small volume ultrasonic nebulizer	Taxable (no change)	2 per year
B4035 * + ^	Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape	Taxable	31 per month
E0574	Ultrasonic/electronic aerosol generator with small volume nebulizer	Taxable (no change)	1 in 5 years
S8186 * +	Swivel adaptor	Non-taxable (no change)	2 in 12 months

*  This code must be billed with modifier NU. Modifiers RB and RR are not allowed.
+  This code is for patient-owned equipment.
^  This code must be billed using the “from-through” (block-billing) method when billing for more than one day of service.

HCPCS code A7016 may be reimbursed only when used with code E0574. Authorization for rental of code E0574 may be granted in increments of up to three months, both for the initial authorization and for reauthorization. Authorization for purchase of code E0574 may be granted for one device every five years. Claims for code E0574 must include modifier NU, RR or RB.

HCPCS code S8186 is not covered by Medicare and should be billed to Medi-Cal directly.

HCPCS codes A4224 and A4225 are reimbursable under the Presumptive Eligibility for Pregnant Women (PE4PW) program.

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

Provider Manual(s)	Page(s) Updated
AIDS Waiver Program Chronic Dialysis Clinics Heroin Detoxification Home Health Agencies/Home and Community-Based Services Hospice Care Program Medical Transportation Psychological Services Rehabilitation Clinics Vision Care	medi non hcp (1)
Audiology and Hearing Aids	medi non hcp (1); tax (6–8, 10, 12, 13)
Durable Medical Equipment	dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); tax (6–8, 10, 12, 13)
General Medicine Obstetrics Clinics and Hospitals	medi non hcp (1); presum bill (12)
Orthotics and Prosthetics	dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1); tax (6–8, 10, 12, 13)
Pharmacy	dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); presum bill (12); tax (6–8, 10, 12, 13)
Therapies	dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1)

Effective retroactively for dates of service on or after January 1, 2016, the frequency limit of HCPCS code J7307 (etonogestrel [contraceptive] implant system, including implant and supplies) is removed. Effective retroactively for dates of service on or after October 1, 2016, the frequency limits of HCPCS codes J7297 (levonorgestrel-releasing intrauterine contraceptive system, [liletta], 52 mg) and J7298 (levonorgestrel-releasing intrauterine contraceptive system, [mirena], 52 mg) are removed.

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

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

Provider Manual(s)	Page(s) Updated
Clinics and Hospitals General Medicine Obstetrics	fam planning (9, 11)
Family PACT	ben fam (23, 30); ben grid (24)

Effective for dates of service on or after December 1, 2019, the maximum dose restriction of 300 units for HCPCS code J0133 (injection, acyclovir, 5 mg) has been removed.

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 drug a-d (3)

Effective for dates of service on or after July 1, 2019, HCPCS code J0570 (buprenorphine implant, 74.2 mg) cannot be billed with ICD-10-CM diagnosis code F11.23 (opioid dependence with withdrawal) for reimbursement.

A new DUR Educational Article titled “Alert: New Global Guidelines for the Treatment of Asthma” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

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Pages updated due to ongoing provider manual revisions: