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):
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) |
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) |
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:
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