Medi-Cal Update

Orthotics and Prosthetics | August 2017 | Bulletin 503

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1. Get the Latest Medi-Cal News: Subscribe to MCSS Today


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2. 2017 CPT-4/HCPCS Annual Update: Policy Updates

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 are 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. Manual replacement pages reflecting these changes will be released in a future Medi-Cal Update.

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.

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3. 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 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
Orthotics and Prosthetics
Psychological Services
Rehabilitation Clinics
Vision Care
cal child sar (1, 12); genetic (4, 5)
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4. September 2017 Medi-Cal Provider Seminar

The September Medi-Cal provider seminar is scheduled for September 26 – 27, 2017, at the Ontario Convention Center in Ontario, 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, the Department of Health Care Services (DHCS) and the DHCS Fiscal Intermediary 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 12, 2017, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After September 12, 2017, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page of the Medi-Cal website.


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 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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5. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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