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)

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:

• SB 219 LGBT Training Add-On ($0.05)
• Standards of Participation-Infection Control ($3.69)
• SB 3 2019 Minimum Wage ($0.32)
• 2018 – 2019 QAF ($15.72)

2017 – 2018 Add-ons:

• SB 3 Minimum Wage (January 2018 Included) ($1.36)
• Standards of Participation ($0.01)

2016 – 2017 Add-ons:

• SB 3 Minimum Wage ($0.17)
• 2016 – 2017 Payroll-Based Journal ($0.13)
• AB 10 Minimum Wage ($0.35)

2015 – 2016 Add-ons:

• AB 10 July 2014 Minimum Wage ($0.06)
• ACA Reporting ($0.54)
• Paid Sick Leave ($1.72)

2014 – 2015 Add-ons:

• ACA Reinsurance Fee and PCORI ($0.03)

2013 – 2014 Add-on carry over:

• ACA Reinsurance Fee and PCORI ($0.04)
• ACA Compliance Program ($0.66)
• HIPPA EFT and RA ($0.03)

2012 – 2013 Add-on carry over:

• Informed Consent ($0.19)
• Standard Admissions Agreement ($0.02)
• Elder Justice Act ($0.01)

2011 – 2012 Add-on carry over:

• Immunization/Vaccine for Airborne Diseases ($0.25)
• Minimum Data Set ($0.51)

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

Provider Manual(s)	Page(s) Updated
Long Term Care	rate facil diem (8, 9)

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:

• EPSDT PDHC


• EPSDT PDN

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)

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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Pages updated due to ongoing provider manual revisions: