Medi-Cal Update

Inpatient Services | August 2019 | Bulletin 539

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1. Telehealth Policy Update for Medi-Cal and Family PACT Programs

Effective for dates of service on or after July 1, 2019, telehealth policy is updated pursuant to Assembly Bill 415 (Logue, Chapter 547, Statutes of 2011), known as the Telehealth Advancement Act of 2011. Benefits or services covered under the Medi-Cal and Family PACT programs, identified by CPT or HCPCS codes and subject to all existing Medi-Cal and Family PACT coverage and reimbursement policies, including any Treatment Authorization Request (TAR) requirements, may be provided via a telehealth modality, if all of the following are satisfied:

Health care providers are required to document Place of Service code “02” on the claim, which indicates that services were provided or received through a telecommunications system.

Modifier GT is no longer required. Covered benefits or services provided via a telehealth modality are reimbursable when billed in one of two ways:

In addition, CPT code 99451 (interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician) is reimbursable for e-consults.

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics may also bill their respective services via a telehealth modality.

Modifier 95 is required to bill for Local Educational Agency (LEA) Medi-Cal Billing Option Program services provided via a telehealth modality.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers ind health (9–14); rural (11–16)
Chronic Dialysis Clinics modif used (2)
Clinics and Hospitals ind health (9–14); medne tele (1–11); modif used (2); rural (11–16); tar and non cd9 (9)
Family PACT ben clinic (6)
General Medicine medne tele (1–11); modif used (2); tar and non cd9 (9)
Inpatient Services tar and non cd9 (9)
Local Educational Agency loc ed bil (12); loc ed bil cd (1, 3–6, 19, 20); loc ed serv spe (6–15); loc ed tele (3)
Obstetrics modif used (2); tar and non cd9 (9)
Rehabilitation Clinics modif used (2)
Vision Care pro serv (6)
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2. BCG Vaccine is No Longer a Medi-Cal Benefit

Effective for dates of service on or after July 1, 2019, CPT code 90586 (Bacillus Calmette-Guerin vaccine [BCG] for bladder cancer, live, for intravesical use) is no longer a Medi-Cal benefit.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics immun (3); inject cd list (3)
Clinics and Hospitals
General Medicine
Obstetrics
immun (3); inject cd list (3); non ph (23); tar and non cd9 (1)
Inpatient Services tar and non cd9 (1)
Rehabilitation Clinics immun (3); inject cd list (3); non ph (23)
Pharmacy immun (3); inject cd list (3)
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3. CCS Service Code Groupings Update

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

Claims require an approved Service Authorization Request (SAR) specific to the code.

End-dated Codes:
Effective Date Codes SCGs
February 1, 2018 HCPCS codes C9014, C9015, J1428 and J2326 01, 02, 03 and 07

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, 2, 13)
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4. September 2019 Medi-Cal Provider Seminar

The September Medi-Cal Provider Seminar is scheduled for September 17 – 18, 2019, at the Visalia Convention Center in Visalia, 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 September 3, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 3, 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 representative.

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

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5. 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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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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