Medi-Cal Update

Home Health Agencies/Home and Community-Based Services | September 2019 | Bulletin 540

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1. Erroneous Payment Correction for EPSDT Home Health Nursing Local Codes

A previously published NewsFlash article titled “Correction: Nursing Local Codes Are Reimbursable for EPSDT Home Health” announced a change in billing instructions for suggested HIPAA-compliant national code equivalents to the previously used HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health Services.

Providers were advised not to bill HCPCS Level II codes T1030 and T1031 (nursing care, in the home) per diem codes and to instead continue to bill local codes Z5805 (EPSDT shared nursing RN) and Z5807 (EPSDT shared nursing LVN) in order to receive the previous hourly rate.

Claims for codes T1030 and T1031 with dates of service on or after July 1, 2018 will be reprocessed via an Erroneous Payment Correction (EPC). Providers should continue to submit claims in a timely manner.

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2. Update to EPSDT Home Health Code Conversion Billing Instructions

In September 2018, policy information was published regarding the EPSDT Home Health Code Conversion. The billing instructions for HCPCS Level II codes T1030 and T1031 have been updated.

Information regarding the changes in billing instructions as well as the updated crosswalk for this conversion is available below as well as on the HIPAA: Code Conversions webpage of the Medi-Cal website under the EPSDT Services: Home Health heading:

Providers are encouraged to visit the HIPAA: Code Conversions page and NewsFlash area of the Medi-Cal website for updates regarding EPSDT home health services and to read their monthly Medi-Cal Update.

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3. 2020 ICD-10-CM/PCS Codes Annual Update

Effective for dates of service on or after October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) has updated ICD-10-CM and ICD-10-PCS codes for the 2020 annual ICD-10 update.

Information and downloads for these codes can be found at the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update and Family PACT Update.

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4. Updated Policy for Postpartum Office Visits

Effective for dates of service on or after October 1, 2019, billing policy for local code Z1038 (postpartum visit) is limited to one in six months unless medical documentation is present. Any additional postpartum visits billed with Z1038 are required to include documentation of a medical or mental health postpartum risk factor or complication. The documentation should appear either in the Remarks field (Box 80)/Additional Claim Information field (Box 19) of the claim, or an attachment for reimbursement.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
preg early (4); preg glo (3); preg per (2); preg post (4)
Home Health Agencies/Home and Community-Based Services
Inpatient Services
preg post (4)
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5. National Correct Coding Initiative Quarterly Update for October 2019

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 October 1, 2019.

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

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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.

Changes, effective July 1, 2019
NDC Labeler Code Contracting Company's Name
59310 TEVA RESPIRATORY, LLC

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 (13)
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7. October 2019 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 29 – 30, 2019, at the Pasadena Convention Center in Pasadena, California. Providers can access a class schedule for the seminar by visiting the Provider Training web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by October 15, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 15, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.

Note:  Wi-Fi will not be provided at the seminar. Please plan accordingly.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative web page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a regional representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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8. 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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