Medi-Cal Update

Heroin Detoxification | December 2019 | Bulletin 543

Print Medi-Cal Update
 

1. October 2019 HCPCS Quarterly Update: Policy Updates

The October 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the Quarter 4 HCPCS Policy (Medi-Cal) PDF. Only those codes representing Medi-Cal benefits effective October 1, 2018, are included in the list of updates.

Please refer to the 2018 HCPCS Level II code book for complete descriptions of these codes.

Providers should refer to the HCPCS Annual Update page for ongoing updates.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12)
Clinics and Hospitals
General Medicine
chemo drug a-d (14, 15, 21); chemo drug e-o (2, 3, 17–19, 21–24); chemo drug p-z (15, 25, 26); inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25); ophthal (15–17, 19–22); surg integ (4, 5, 9)
Obstetrics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Rehabilitation Clinics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Pharmacy inject an over (1); inject cd list (2–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 9, 13, 17, 22–24)
Print Article | Return to Top
 

2. 2020 CPT Annual Update

The 2020 updates to the Current Procedural Terminology (CPT) codes are available in the 2020 CPT Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2020. Please refer to the 2020 CPT code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
cardio (9, 10); chemo an over (1); epsdt chdp school (5); eval (31); inject an over (1); inject cd list (9); medne neu (3, 4, 8); medne non (1); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); ophthal (2, 4, 10); ophthal cd (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); surg cardio (9); surg eye (1); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Obstetrics eval (31); inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Rehabilitation Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); vaccine (4)
Chronic Dialysis Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); vaccine (4)
Inpatient tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10)
Local Educational Agencies loc ed bil cd (8, 10, 11, 14, 22); loc ed serv nurs (5); loc ed serv physican (5); loc ed serv psych (7); modif app (12, 13)
Vision Care modif app (12, 13); modif used vc (2); pro serv (4, 11, 17, 19, 20); pro serv cd (7, 8); rates max optom (2)
Pharmacy inject an over (1); inject cd list (9); presum bill (10, 11)
AIDS Waiver Program modif (3); modif app (12, 13)
Print Article | Return to Top
 

3. Incontinence Medical Supply Claims Billable with Select HCPCS Codes

Effective for dates of service on or after January 1, 2020, incontinence medical supply claims for Other Health Coverage (OHC) Code of “F”, Medicare Part C Health Plan are billable to Medi-Cal with HCPCS Codes A4554, T4521–T4537 and T4540–T4544.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
General Medicine
Medical Transportation
Obstetrics
Outpatient Services
oth hlth cpt (2)
Print Article | Return to Top
 

4. National Correct Coding Initiative Quarterly Update for January 2020

The Centers for Medicare & Medicaid Services (CMS) are scheduled to routinely release the quarterly National Correct Coding Initiative (NCCI) in Medicaid payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and will be effective for dates of service on or after January 1, 2020.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

Print Article | Return to Top
 

5. Authorized Drug Manufacturer Labeler Codes Update

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

Changes, effective December 1, 2019
NDC Labeler Code Contracting Company’s Name
00642 EXELTIS USA, 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
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (5, 21)
Print Article | Return to Top
 

6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

MCSS Logo

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.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

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

Print Article | Return to Top
 

7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

Print Article | Return to Top


Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.