Medi-Cal Update

Home Health Agencies/Home and Community-Based Services | October 2018 | Bulletin 529

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1. EPSDT Home Health Services Local Code Conversion Webinars begin in November

Medi-Cal providers now have the opportunity to attend free online webinars pertaining to the January 1, 2019 code conversion and billing services for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health services.

Webinars are presented live with dates as follows:

Webinars are accessible through the Medi-Cal Learning Portal (MLP). First-time webinar attendees must complete the registration prior to attending. Once registered, view the webinar schedule and/or RSVP for training on the Training Calendar.

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2. HIPAA Notice of Code Conversion for Sign Language Interpreter Services

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324 and Z0326 for sign language interpreter services will be replaced with HIPAA-compliant national HCPCS Level II code T1013. HCPCS Level III local codes Z0328 and Z0329 will be terminated.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility required by law to provide sign language interpreter services.

The Sign Language Interpreter Services Code Conversion Crosswalk and additional information for this project will publish as details are determined.

Providers are encouraged to routinely check the Medi-Cal Update bulletin or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles, and/or System Status Alerts.

For additional information, providers may:

All other questions for the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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3. Sign Language Interpreter Code Conversion Billing Instructions

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324, Z0326, Z0328 and Z0329 for sign language interpreter services will be discontinued. Codes Z0324 and Z0326 will be replaced by national HIPAA-compliant HCPCS Level II code T1013. HCPCS Level II national code T1013 will be required to bill sign language interpreter services. Providers submitting UB-04 claim forms or ANSI 837I transactions must bill revenue codes in addition to national procedure codes. The Sign Language Interpreter Services Code Conversion Crosswalk is available for reference.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility that is required by law to provide sign language interpreter services.

Updated manual pages will be released in a future Medi-Cal Update.

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4. Sign Language Interpreter Services Code Conversion: Frequently Asked Questions

Effective for dates of service on or after January 1, 2019, the sign language interpreter services code conversion replaces HCPCS Level III local codes with HIPAA-compliant HCPCS Level II national billing codes. Providers are encouraged to familiarize themselves with the Sign Language Interpreter Services Code Conversion: Frequently Asked Questions.

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5. Drug Products Requiring SAR Added for CCS and GHPP

The following drug products are added to the pharmacy list of drugs and nutritional products that require a separate Service Authorization Request (SAR) for the California Children's Services (CCS) program and Genetically Handicapped Persons Program (GHPP).

Retroactive
Effective Date
Drug Product
August 1, 2017 Tisagenlecleucel

Triptorelin pamoate
October 1, 2017 Axicabtagene ciloleucel
November 1, 2017 Emicizumab-KXWH

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Clinics and Hospitals
Chronic Dialysis Clinics
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (7, 8); genetic (10, 11)
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6. Authorized Drug Manufacturer Labeler Codes Update

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

Additions, effective October 1, 2018
NDC Labeler Code Contracting Company's Name
00990 ICU MEDICAL INC.
36000 BAXTER HEALTHCARE CORPORATION
65628 CUTISPHARMA, INC.
69536 FOUNDATION CONSUMER HEALTHCARE, LLC
70010 GRANULES PHARMACEUTICALS, INC.
70255 ARRAY BIOPHARMA INC.
70621 BIOFRONTERA INC.
71045 ACHAOGEN, INC.
71104 BIOVERATIV US LLC
71334 AGIOS PHARMACEUTICALS, INC.
71428 GLASSHOUSE PHARMACEUTICALS LLC
71930 EYWA PHARMA
76336 HRA PHARMA AMERICA INC.
   
Terminations, effective October 1, 2018
NDC Labeler Code Contracting Company's Name
15310 CREEKWOOD PHARMACEUTICAL, INC.
24477 EKR THERAPEUTICS, INC.
24486 ARISTOS PHARMACEUTICALS, INC.
58181 NEXTSOURCE BIOTECHNOLOGY, LLC
58604 SPROUT PHARMACEUTICALS, INC.
69051 PROFOUNDA, INC.
69654 AYTU BIOSCIENCE, 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, 7, 8, 12, 15, 18–20)
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7. Electronic SAR Now Supports Attachments

California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can now submit Service Authorization Requests (SARs) in an electronic format (eSAR) with attachments. Attachments must be in format of PDF, JPG or TIF. Attachments must be less than 15 megabytes (MB) in size, with the sum of all attachments being less than 150 MB. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit eSARs, providers must:

Then, select one of the available options to submit:

Registered providers and clearinghouses can complete and submit the eSAR requests on behalf of the providers and facilities in their network.

Paper SAR submissions remain an option for low-volume SAR providers or submitters who may have technical limitations or practical reasons to do so.

Providers interested in learning more about eSAR submissions should contact the CMS Net Help Desk at cmshelp@dhcs.ca.gov or 1-866-685-8449 for helpful guidance and additional information.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (12); genetic (4)
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8. Valid Revenue Codes for Outpatient Services

For dates of service on or after January 1, 2019, a four-digit revenue code must be included on outpatient claims billed on paper UB-04 claim forms (Box 42) or ANSI 837I transactions for electronic billing (FL42; reference ASC X12N 837 v.5010 Loop 2400 Segment SV201).

A revenue code identifies specific accommodations, ancillary services, or unique billing calculations or arrangements. As defined by the National Uniform Billing Committee (NUBC) and required by the HIPAA, services covered in an outpatient setting require a valid four-digit revenue code to accompany the CPT and HCPCS national procedure code(s).

Outpatient claims with dates of service on or after January 1, 2019, that are submitted on paper UB-04 claim forms or ANSI 837I transactions with missing, incomplete, or invalid revenue codes will be denied.

Providers may contact the Telephone Service Center (TSC) at 1-800-541-5555 for claims assistance.

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9. National Correct Coding Initiative Quarterly Update for October 2018

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after October 1, 2018.

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

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

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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.

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11. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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