Medi-Cal Update

Long Term Care | January 2019 | Bulletin 503

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1. 2019 HCPCS Annual Update: Policy Updates

The 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2019 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 are effective for dates of service on or after February 1, 2019. Providers should refer to the 2019 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
AIDS Waiver Program
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Psychological Services
Therapies
Vision Care
medi non hcp (2)
Audiology and Hearing Aids hear aid bill (3, 4); hear aid cd (1, 3); medi non hcp (2); tax (10)
Chronic Dialysis Clinics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12)
Clinics and Hospitals
General Medicine
chemo an over (2); chemo drug a-d (3, 8, 23, 24, 31); chemo drug e-o (7, 8, 18, 21); chemo drug p-z (9–12, 19, 20); inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); medne tele (5); modif used (12); non ph (12–14, 25–27); once (1); ophthal (16); radi dia ult (3); radi onc (7–9); surg eye (14); surg integ (5); surg nerv (3)
Durable Medical Equipment
Orthotics and Prosthetics
medi non hcp (2); tax (10)
Obstetrics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27); once (1); radi dia ult (3); radi onc (7–9)
Pharmacy inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); tax (10)
Rehabilitation Clinics inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27)
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2. 2018 – 2019 Freestanding Pediatric Subacute Rates Update

Effective for dates of service on or after August 1, 2018, the 2018 – 2019 reimbursement rates are updated for Freestanding Pediatric Subacute (FS/PSA) facilities.

Facilities should begin using these rates to bill for services. Facilities do not need to rebill to adjust their payments. Claims with effective dates of service on or after August 1, 2018, will be processed. Provider rate letters have been sent to all FS/PSA facilities with notification of the rate updates. Rates are also posted on the Distinct Part Pediatric Subacute (DP/PSA) and Freestanding Pediatric Subacute (FS/PSA) Facilities page of the Department of Health Care Services website.

Final FS/PSA Reimbursement Rates:
The 2018 – 2019 FS/PSA rates continue to be frozen at their 2008 – 2009 rates, plus the cost of new state and federal mandates (add-ons). The add-ons are not applied to rehabilitation therapy and ventilator weaning rates.

Freestanding Pediatric Subacute 2018 – 2019 – Frozen Rates
Accommodation Code Description Rate
91 Free-standing NF-B – Ventilator Dependent; Regular Service $ 800.39
92 Free-standing NF-B – Non-ventilator Dependent; Regular Service $ 731.76
93 Free-standing NF-B – Ventilator Dependent; Bed Hold $ 792.47
94 Free-standing NF-B – Non-ventilator Dependent; Bed Hold $ 723.84
95 Free-standing NF-B – Ventilator Dependent; Leave of Absence $ 792.47
96 Free-standing NF-B – Non-ventilator Dependent; Leave of Absence $ 723.84
97 Free-standing DP/NF-B – Supplemental Rehabilitation Therapy Services $ 50.35
98 Free-standing DP/NF-B – Ventilator Weaning Services $ 46.94

2018 – 2019 Add-ons:

2017 – 2018 Add-ons:

2016 – 2017 Add-ons:

2015 – 2016 Add-ons:

2014 – 2015 Add-ons:

2013 – 2014 Add-on carry over:

2012 – 2013 Add-on carry over:

2011 – 2012 Add-on carry over:

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

Provider Manual(s) Page(s) Updated
Long Term Care rate facil diem (8, 9)
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3. EPSDT PDHC and PDN: TAR Submission Update

Effective immediately, providers rendering Pediatric Day Health Care (PDHC) or Private Duty Nursing (PDN) services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit must indicate so on their Treatment Authorization Requests (TARs).

For electronic TARs (eTARs), providers must select the appropriate special handling code on the Patient Information page:

For paper 50-1 TARs, providers must include “EPSDT PDHC” or “EPSDT PDN” in the Specific Services Requested field (Box 10A).

For additional TAR information, contact: PDNinquiries@dhcs.ca.gov.

Any email containing protected health information (PHI) or personal information (PI) should be sent via secure or encrypted email.

Note:

California Children’s Services’ (CCS) Service Authorization Requests (SARs) are not affected by this update.

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
Inpatient Services
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Psychological Services
Rehabilitation Clinics
Therapies
Pharmacy
tar comp (8); tar field (2); cal child (3)
Adult Day Health Care Centers
Heroin Detoxification
Hospice Care Program
tar comp (8); tar field (2)
Long Term Care tar field (2)
Home Health Agencies/Home and Community-Based Services ped (3); tar comp (8); tar field (2); cal child (3)
Local Educational Agency
Vision Care
cal child (3)
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4. National Correct Coding Initiative Quarterly Update for January 2019

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 January 1, 2019.

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

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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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