Medi-Cal Update

Inpatient Services | September 2017 | Bulletin 516

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1. 2017 CPT-4/HCPCS Annual Update: Manual Replacement Page Release

The 2017 updates to the Current Procedural Terminology – 4th edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2017 CPT-4/HCPCS 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 will be effective for dates of service on or after October 1, 2017. Please refer to the 2017 CPT-4 and HCPCS Level II code books for complete descriptions of these codes.

Additionally, the 2017 CPT-4 codebook was updated to allow separate reimbursement for moderate (conscious) sedation for multiple codes that had previously included moderate (conscious) sedation as an inherent part of providing the procedure. Please refer to the 2017 CPT-4 codebook for instructions on how to bill for this service with other codes.

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
medi cr op pr (7)
Audiology and Hearing Aids tax (7, 8)
Chronic Dialysis Clinics immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8–10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); medi cr op pr (7); medi non cpt (1, 2); modif used (4–7, 9–12); non inject (9–11); path bil (1, 4–7, 9); path organ (9); vaccine (2–4, 9)
Clinics and Hospitals altern (3); anest (11, 13, 16, 28); cardio (14–16, 19); chemo drug a-d (8, 9, 21); chemo drug e-o (2, 3, 10, 11, 17); chemo drug p-z (10, 12–14, 18); eval (17); immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8–10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); medi cr op pr (7); medi non cpt (1, 2); medne non (1); medne oto (4); medne tele (4, 5); modif used (4–7, 9–12); non inject (9–11); non ph (8, 10–12, 21–24); once (6); ophthal (2); path bil (1, 4–7, 9); path drug (2–4); path molec (10, 11, 22, 36, 37); path organ (9); presum (10, 15, 17, 18); radi (2); radi dia (24–26, 28, 29, 31); radi dia ult (3); radi nuc (6, 7); radi onc (2–4, 7); respir (4, 7); surg (2, 5); surg bil mod (7, 8); surg bill ub (5, 6, 10, 11); surg cardio (2, 3, 9); surg integ (4, 5); surg muscu (1, 7); surg nerv (1); tar and non cd1 (2); tar and non cd2 (2, 4, 5); tar and non cd3 (2, 7, 8); tar and non cd6 (2, 5); tar and non cd8 (2, 3); tar and non cd9 (1, 5, 6, 8); vaccine (2–4, 9)
Durable Medical Equipment dura bil wheel (4, 5); dura cd (4, 6, 23, 25, 28–30, 33, 35, 39); dura cd fre (1); ortho cd1 (12–14); ortho cd fre1 (1, 2); respir (4, 7); tax (7, 8)
General Medicine altern (3); anest (11, 13, 16, 28); cardio (14–16, 19); chemo drug a-d (8, 9, 21); chemo drug e-o (2, 3, 10, 11, 17); chemo drug p-z (10, 12–14, 18); eval (17); immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8–10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); medi non cpt (1, 2); medne non (1); medne oto (4); medne tele (4, 5); modif used (4–7, 9–12); non inject (9–11); non ph (8, 10–12, 21–24); once (6); ophthal (2); path bil (1, 4–7, 9); path drug (2–4); path molec (10, 11, 22, 36, 37); path organ (9); presum (10, 15, 17, 18); radi (2); radi dia (24–26, 28, 29, 31); radi dia ult (3); radi nuc (6, 7); radi onc (2–4, 7); respir (4, 7); surg (2, 5); surg bil cms (4, 5, 8, 9); surg bil mod (7, 8); surg cardio (2, 3, 9); surg integ (4, 5); surg muscu (1, 7); surg nerv (1); tar and non cd1 (2); tar and non cd2 (2, 4, 5); tar and non cd3 (2, 7, 8); tar and non cd6 (2, 5); tar and non cd8 (2, 3); tar and non cd9 (1, 5, 6, 8); vaccine (2–4, 9)
Inpatient Services tar and non cd1 (2); tar and non cd2 (2, 4, 5); tar and non cd3 (2, 7, 8); tar and non cd6 (2, 5); tar and non cd8 (2, 3); tar and non cd9 (1, 5, 6, 8)
Obstetrics altern (3); anest (11, 13, 16, 28); eval (17); immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8–10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); medi non cpt (1, 2); modif used (4–7, 9–12); non inject (9–11); non ph (8, 10–12, 21–24); once (6); path bil (1, 4–7, 9); path drug (2–4); path molec (10, 11, 22, 36, 37); path organ (9); presum (10, 15, 17, 18); radi (2); radi dia (24–26, 28, 29, 31); radi dia ult (3); radi nuc (6, 7); radi onc (2–4, 7); surg (2, 5); surg bil cms (4, 5, 8, 9); surg bil mod (7, 8); tar and non cd1 (2); tar and non cd2 (2, 4, 5); tar and non cd3 (2, 7, 8); tar and non cd6 (2, 5); tar and non cd8 (2, 3); tar and non cd9 (1, 5, 6, 8); vaccine (2–4, 9)
Orthotics and Prosthetics dura cd (4, 6, 23, 25, 28–30, 33, 35, 39); dura cd fre (1); ortho (22); ortho cd1 (12–14); ortho cd fre1 (1, 2); tax (7, 8)
Pharmacy dura bil wheel (4, 5); dura cd (4, 6, 23, 25, 28–30, 33, 35, 39); dura cd fre (1); immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8, 9, 10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); ortho (22); ortho cd1 (12–14); ortho cd fre1 (1, 2); presum (10, 15, 17, 18); tax (7, 8)
Psychological Services psychol cd (1); psychol ex (2)
Rehabilitation Clinics immun (9, 10, 19); immun cd (1, 2); inject cd list (2, 3, 5, 6, 8, 9, 11, 12, 14–16); inject drug a-d (6, 8–10, 33); inject drug e-h (21, 22, 28, 30); inject drug i-m (6, 13); inject drug n-r (11, 12); inject drug s-z (2, 15); inject hydra (2); medi cr op pr (7); modif used (4–7, 9–12); non inject (9–11); non ph (8, 10–12, 21–24); respir (4, 7); vaccine (2–4, 9)
Therapies dura cd (4, 6, 23, 25, 28–30, 33, 35, 39); dura cd fre (1); ortho cd1 (12–14); ortho cd fre1 (1, 2); respir (4, 7)
Vision Care medi non cpt (1, 2)
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2. Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)

A new DUR Educational Article titled “Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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3. 2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines

A new DUR Educational Article titled “2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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4. 58661 and 58700 New Benefits for Family PACT and TAR Removed for Medi-Cal

Effective for dates of service on or after October 1, 2017, CPT-4 codes 58661 (laparoscopy, surgical; with removal of adnexal structures [partial or total oophorectomy and/or salpingectomy]) and 58700 (salpingectomy, complete or partial, unilateral or bilateral) are Family Planning, Access, Care, and Treatment (Family PACT) Program benefits.

CPT-4 codes 58661 and 58700 are reimbursable for females only with ICD-10-CM diagnosis code Z30.2 (encounter for sterilization). Sterilization Consent Form (PM 330) is required. If CPT-4 codes 58661 and 58700 are elective sterilization procedures, there is no Treatment Authorization Request (TAR) requirement under the Family PACT and Medi-Cal programs.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Inpatient Services
Obstetrics
ster (20)
Family PACT ben fam (39, 40); ben grid (7)
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5. CCS Service Code Groupings Update

The following codes will be end-dated from the California Children's Services (CCS) Service Code Groupings (SCGs).

End-Dated Codes:
Effective Date Code SCGs
April 1, 2017 HCPCS codes X7700, X7702 01, 02, 03, 07, 12

The following codes will be added to the California Children's Services (CCS) Service Code Groupings (SCGs).

Added Codes:
Effective Date Code SCGs
April 1, 2017 HCPCS codes J7030, J7040, J7042, J7050, J7060, J7070, J7120 01, 02, 03, 07, 12

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
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 ser (1–3, 28, 29)
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6. All Patient Refined Diagnosis-Related Group Reimbursement for Fiscal Year 2017 – 2018

The Department of Health Care Services (DHCS) received approval from the Centers for Medicare & Medicaid Services (CMS) for State Plan Amendment (SPA) 17-015, which modifies the all patient refined diagnosis-related group (APR-DRG) reimbursement methodology for state fiscal year 2017 – 2018. The following changes apply to general acute inpatient hospital services provided by private hospitals and non-designated public hospitals in California, out-of-state (border and non-border) hospitals and Medicare-designated critical access hospitals effective July 1, 2017.

Access SPA #17-015 on the DHCS website. The SPA is on the DRG Important Information page under the “Approved State Plan Amendments (SPA)” heading.

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7. Update to Guidelines for SAR and eSAR Submission

California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can submit Service Authorization Requests (SARs) in an electronic format for fee-for-service claims. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit electronic SARs (eSARs), providers must:

Then select one of the submission options:

  1. Utilize the newly enhanced online fillable form of the PEDI system to submit SARs electronically
  2. Generate and submit one of the supported file-based transmission formats:
    • Web-based file upload utility in the eSAR system to submit ASC X12 278 transactions
    • Simple Object Access Protocol (SOAP)/Hypertext Transfer Protocol Secure (HTTPS) secure web services method to transmit and receive ASC X12 278 transactions

Registered providers, clearinghouses or Managed Care Plans 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 other practical reasons to do so.

Providers interested in converting from paper SAR to eSAR submission 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 (1, 12); genetic (4, 5)
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8. Clinical Review: Drug-Induced QT Interval Prolongation

A new DUR Educational Article titled “Clinical Review: Drug-Induced QT Interval Prolongation” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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9. Updated Address and Telephone Number for Sierra County Behavioral Health

The address for the Sierra County Behavioral Health Department is updated as follows:

Sierra County Behavioral Health Department
c/o Placer County Mental Health Services
Attn: TAR Processing Unit
11512 B Avenue
Auburn, CA  95603

The telephone and fax numbers are updated as follows:

Telephone Number Fax Number
(530) 886-2929 (530) 886-2940

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Psychological Services
spec cnty (9)
Inpatient Services inp ment pln (7)
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10. October 2017 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 17, 2017, at the Embassy Suites in San Luis Obispo, California. Providers can access a class schedule for the seminar by visiting the Provider Training 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, Department of Health Care Services (DHCS) and Conduent, the Fiscal Intermediary 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 3, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 3, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page on the Medi-Cal website.

Note:

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

Providers who 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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11. 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 for urgent announcements and other updates shortly, after posting 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
  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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12. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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.