Medi-Cal Update

Obstetrics | January 2020 | Bulletin 547

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1. New Medi-Cal Provider Website Nearing Completion

The Department of Health Care Services (DHCS) is nearing completion of the new Medi-Cal Provider website. DHCS anticipates this new website to be available to providers beginning in the spring of 2020.

This new Medi-Cal Provider website will contain content from the current Medi-Cal website but will offer the following additional features:

Access to Outreach and Education, including provider training, and Transaction Services will continue to be available from the Providers tab located within the navigation bar of the home page of the new website.

DHCS will publish additional updates about the new Medi-Cal Provider website in the coming months leading up to the spring of 2020. Providers are encouraged to regularly check the current Medi-Cal website as well as subscribe to the Medi-Cal Subscription Service (MCSS) to ensure they receive the latest policy and program updates.

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2. 2020 HCPCS Annual Update

The 2020 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the 2020 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 January 1, 2020. Please refer to the 2020 HCPCS code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
chemo drug e-o (9); chemo drug p-z (7–9); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); surg eye (12); vaccine (4)
Obstetrics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); presum bill (12); radi nuc (3, 4); radi onc (12, 13); vaccine (4)
Pharmacy dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mc sup (2); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); presum bill (12); tax (9, 10)
Durable Medical Equipment dura bil wheel (6); dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); dura inf (3); dura other (22); mc sup (2); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Orthotics and Prosthetics dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho auth ortho (31, 32); ortho auth pros (42); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3); tax (9, 10)
Therapies dura cd (23, 39, 46); dura cd fre (1, 2, 4, 5); ortho cd 1 (16); ortho cd 2 (20); ortho cd fre 1 (2); ortho cd fre 2 (3)
Rehabilitation Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); non ph (9, 12–14, 24, 25); vaccine (4)
Chronic Dialysis Clinics inject cd list (3, 7, 9, 10, 11, 13); inject drug a-d (22–24); inject drug i-m (14); mod if used (4); vaccine (4)
Psychological Services psychol (4, 9); psychol cd (3)
Audiology tax (9, 10)
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3. 2019 ICD-10-CM Diagnosis Codes: Provider Manual Updates

The 2019 ICD-10-CM diagnosis codes have been updated in the Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) provider manuals.

The codes were previously rolled out and are effective retroactively for dates of service on or after October 1, 2018. Certain ICD-10-CM diagnosis codes have been:

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required by providers.

Information and downloads for these codes can be found on the 2019 ICD-10-CM web page of the Centers for Medicare & Medicaid Services (CMS) website.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics path chem (4)
Clinics and Hospitals
General Medicine
ophthal cd (2); path chem (4); radi dia ult (1); surg eye (11)
Family PACT ben fam (47, 48, 54); lab (19–22, 24, 25, 37)
Obstetrics path chem (4); radi dia ult (1)
Vision Care pro serv cd (2)
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4. Evaluation and Management: New Benefits and Place of Service Updates

Effective for dates of service on or after February 1, 2020, CPT codes 99415 (prolonged clinical staff service [the service beyond the typical service time] during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour) and 99416 (…each additional 30 minutes) are Medi-Cal benefits. Modifiers SA, SB, U7, 24, 25 and 99 are allowable.

Additionally, the CPT codes listed below are restricted to the following facility type/Place of Service codes:

CPT Code Facility Type
UB-04
Place of Service Code
CMS-1500
99354, 99355 13, 71, 72, 73 11, 22, 24, 25
99356, 99357 11, 12, 25, 26, 27, 65, 71, 73, 74, 75, 76, 86, 89 21, 31, 32, 53, 54, 99
99415, 99416 74, 75, 76, 79, 83 53, 65, 71, 72

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics modif used (3)
Clinics and Hospitals
General Medicine
Obstetrics
eval (2, 4–6, 8); modif used (3); non ph (9, 23); tar and non cd9 (9)
Inpatient Services tar and non cd9 (9)
Rehabilitation Clinics modif used (3); non ph (9, 23)
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5. Ambulatory Blood Pressure Monitoring Added as New Medi-Cal Benefit

Effective for dates of service on or after February 1, 2020, the following CPT® codes are new Medi-Cal benefits for ambulatory blood pressure monitoring (ABPM):

CPT
Code
Description
93784 Ambulatory blood pressure monitoring, utilizing report-generating software, automated, worn continuously for 24 hours or longer; including recording, scanning analysis, interpretation and report
93786  recording only
93788  scanning analysis with report
93790  review with interpretation and report

ABPM is a benefit for the following conditions with no Treatment Authorization Request (TAR) requirement for patients seen in an outpatient facility only. The frequency limit is two times a year for the same patient, any provider.

ABPM devices must be:

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
cardio (8); tar and non cd9 (4)
Inpatient Services
Obstetrics
tar and non cd9 (4)
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6. CYP2C19 Gene Analysis Is a Medi-Cal Benefit

Effective for dates of service on or after February 1, 2020, CPT code 81225 (CYP2C19 [cytochrome P450, family 2, subfamily C, polypeptide 19], gene analysis, common variants) is a Medi-Cal benefit. The frequency limit is once in a lifetime and one of the following ICD-10-CM diagnosis codes is required for reimbursement: I21.01 – I24.9. A Treatment Authorization Request (TAR) may override the frequency limit and ICD-10-CM diagnosis code requirement.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Vision Care
medi non cpt (1)
Clinics and Hospitals
General Medicine
Obstetrics
medi non cpt (1); path molec (14); tar and non cd8 (2)
Inpatient Services tar and non cd8 (2)
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7. Updated Billing Requirements for SMN1 Gene Analysis

Effective for dates of service on or after December 1, 2019, ICD-10-CM diagnosis codes Z34.00 – Z34.03, Z34.80 – Z34.83 and Z34.90 – Z34.93 have been added to the billing requirements for CPT code 81329 (SMN1 [survival of motor neuron 1, telomeric] gene analysis; dosage/deletion analysis, includes SMN2 [survival of motor neuron 2, centromeric] analysis, if performed).

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
path molec (30)
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8. Update to CCS and GHPP Drug/Nutritional Product Exceptions

Effective for dates of service on or after October 1, 2019, the following updates have been made to the California Child Services (CCS) and Genetically Handicapped Persons Program (GHPP) drug/nutritional product exceptions:

Additions Changes
Elexacaftor/ivacaftor/tezacaftor Tezacaftor/Ivacaftor

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
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 Education Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (7, 8); genetic (10, 11)
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9. TAR Criteria Added for the Genetic Testing of Tuberous Sclerosis Complex

Effective for dates of service on or after February 1, 2020, Treatment Authorization Request (TAR) criteria for CPT codes 81405 (molecular pathology procedure, Level 6), 81406 (molecular pathology procedure, Level 7) and 81407 (molecular pathology procedure, Level 8) are added for the genetic testing of tuberous sclerosis complex.

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
path molec (45, 52, 54)
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10. TAR No Longer Required for Naltrexone and Buprenorphine Injections

Effective for dates of service on or after February 1, 2020, a Treatment Authorization Request (TAR) is no longer required when billing for HCPCS codes J2315 (injection, naltrexone, depot form, 1 mg), Q9991 (injection, buprenorphine extended-release [Sublocade], less than or equal to 100 mg) and Q9992 (injection, buprenorphine extended-release [Sublocade], greater than 100 mg).

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitation Clinics
inject drug a-d (24); inject drug n-r (1, 2)
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11. Reminder: Screening for Adverse Childhood Experiences Is a Medi-Cal Benefit

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal benefit. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics will also be able to receive these reimbursements, in addition to their Prospective Payment System (PPS) and all-inclusive per-visit reimbursement.

Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be reimbursed more than once per year, per provider. Screenings for individuals 21 years of age or older will not be reimbursed more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age or older. For individuals 18 or 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age or older is used, it must contain questions on the 10 original categories of ACEs to qualify.

ACEs screenings will be reimbursed in both the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with either of the two HCPCS codes below:

These codes may be billed to Medi-Cal directly even if the recipient has Other Health Coverage (OHC).

For fee-for-service Medi-Cal providers, screenings for ACEs are reimbursed at the Medi-Cal rate up to $29. For Medi-Cal MCPs, screenings for ACEs are reimbursed no less than $29 for each qualifying ACEs screening. Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the recipient and/or family and any clinically appropriate actions were documented. This documentation should remain in the recipient’s medical record and be available upon request. The Department of Health Care Services (DHCS) will release additional information in a future announcement about how FQHCs, RHCs and IHS-MOA clinics can bill for trauma screening.

In order to be eligible for the trauma screening reimbursement after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS launched www.ACEsAware.org, which includes information about DHCS’ provider training and other resources.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care Provider Trainings page of the DHCS website.

An Erroneous Payment Correction (EPC) will be implemented to reprocess any claims erroneously denied for dates of service on or after January 1, 2020. Providers should continue to bill their claims timely and check for updates on the Medi-Cal website.

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
General Medicine
Medical Transportation
Obstetrics
oth hlth cpt (4)
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12. 2020 Medi-Cal Provider Training Schedule

The 2020 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 7 – 30 Webinar Information posted on the Medi-Cal website
February 11 – 12 Seminar Santa Ana
Double Tree by Hilton
201 East MacArthur Blvd.
Santa Ana, CA  92707
March 5 Seminar Concord
Crowne Plaza
45 John Glenn Drive
Concord, CA  91764
March 24 Seminar Santa Rosa
Flamingo Conference Resort & Spa
2777 Fourth Street
Santa Rosa, CA  95405
April 14 – 15 Seminar Riverside
Riverside Convention Center
3637 Fifth Street
Riverside, CA  92501
May 12 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
June 2 – 30 Webinar Information to be published on Medi-Cal website
July 29 – 30 Seminar Escondido
California Center for the Arts
340 North Escondido Blvd.
Escondido, CA  92025
August 26 – 27 Seminar Sacramento
Sacramento Marriott
11211 Point East Drive
Rancho Cordova, CA   95742
September 15 – 16 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
October 14 – 15 Seminar Fresno
Double Tree Hilton
2233 Ventura Street
Fresno, CA  93721
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13. January 2020 Medi-Cal Provider Training Webinars

Beginning January 7, 2020, and continuing throughout the month of January, Medi-Cal providers may participate in provider training webinars that are:

Providers will be able to print class materials and ask questions during the training sessions. Recorded webinars will be archived and available for on-demand viewing from the MLP.

To view the webinars, providers must have internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

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14. February 2020 Medi-Cal Provider Seminar

The February Medi-Cal provider seminar is scheduled for Feb. 11 – 12, 2020, at the Santa Ana Double Tree by Hilton in Santa Ana, California. Providers can access a class schedule for the seminar by visiting the Provider Training webpage of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging into the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the DHCS Fiscal Intermediary (FI) for Medi-Cal, conduct Medi-Cal training seminars. These seminars, which target both new and experienced providers and billing staff, cover the following topics:

Providers must register by January 24, 2020, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 24, 2020, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks webpage 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 request a custom billing workshop presented by a regional field representative. To schedule the regional representative for your area, providers must 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 webpage and refer to it often for current seminar information.

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15. Improving the Quality of Care: Risks Associated with Use of Gabapentin

A new DUR Educational Article titled “Improving the Quality of Care: Risks Associated with Use of Gabapentin” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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16. Policy for Medical Supply Billing Codes Updated to DME Supply Billing Codes

Effective for dates of service on or after February 1, 2020, the following medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes: HCPCS codes A4222, A4230 – A4232, A4483, A7002 – A7004, A7006 – A7008, A7010, A7012, A7013, A7016, B4035 and S8186. Note that codes A4230 – A4232 and A7008 are not benefits.

These HCPCS codes that describe items used in the operation of DME will no longer be medical supply codes on the List of Medical Supplies Billing Codes, Units and Quantity Limits. These HCPCS codes must be billed as DME supply codes.

Updates to Medical Supply Codes
Effective for dates of service on or after February 1, 2020, medical supply HCPCS codes are updated as follows:

A4223 Infusion supplies not used with external infusion pump, per cassette or bag. Use to bill all necessary supplies that are not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to administrative sets and syringes, tubing, extension tubing, connecting devices and port caps) for the administration, without a pump, of non-insulin drugs.

Bill one (1) quantity unit per each administrative/infusion set/kit or per each separate item (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 30 units per 27-day period require authorization.

Documentation of product cost (an invoice, manufacturer’s catalog page or price list) is required as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement.

Refer to DME supply HCPCS code A4222 for infusion supplies used with an external infusion pump.

B4034 Enteral feeding supplies; syringe fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by syringe and maintain the feeding site.
B4036 Enteral feeding supplies; gravity fed. Use to bill supplies not otherwise on the List of Medical Supplies Billing Codes, Units and Quantity Limits (including but not limited to feeding/flushing syringe, administration sets, tubing, extension tubing, connecting devices and port caps) that are necessary to administer enteral feeding by gravity and maintain the feeding site.

For claims using HCPCS code B4034 and B4036, bill one (1) quantity unit per each administrative/supply set/kit or per each separate item, (for example, one extension tubing is equal to one unit). Claims billed for quantities exceeding 31 units per 27-day period require authorization.

HCPCS code B4034 and B4036 require documentation of product cost (an invoice, manufacturer’s catalog page or price list) as an attachment to the claim for reimbursement. The name of the item must be clearly identifiable on the documentation for reimbursement.

Note:

HCPCS code B4035, enteral feeding supplies (pump fed), is updated to a DME supply code.

Effective for dates of service on or after February 1, 2020, HCPCS codes B9998, B9999 and S1015 will be end-dated. Providers must bill the items using the following codes:

Updates to DME Supply Codes
HCPCS codes A4230 – A4232 and A7008 are no longer benefits. The table below specifies policy for new DME supply codes A4483, A7002 – A7004, A7006, A7007, A7010, A7012, A7013, A7016, B4035 and S8186. In addition, policy for codes A4222, A4224, A4225 and E0574 is as follows.


HCPCS Code
Description Taxable/Non-Taxable Frequency Limit, Any Provider
A4222 * + Infusion supplies for external drug infusion pump, per cassette or bag Non-taxable --
A4224 * + ^ Supplies for maintenance of insulin infusion catheter, per week Non-taxable 1 per week
A4225 * + ^ Supplies for external insulin infusion pump, syringe type cartridge, sterile, each Non-taxable 15 per month
A4483 * + ^ Moisture exchanger, disposable, for use with invasive mechanical ventilation Non-taxable (no change) 31 per month
A7002 * + Tubing, used with suction pump, each Non-taxable 4 per month
A7003 * + Administration set, with small volume nonfiltered pneumatic nebulizer, disposable Taxable (no change) 2 per month
A7004 * + Small volume nonfiltered pneumatic nebulizer, disposable Taxable (no change) 2 per month
A7006 * + Administration set, with small volume filtered pneumatic nebulizer Taxable (no change) 1 per month
A7007 * + Large volume nebulizer, disposable, unfilled, used with aerosol compressor Taxable (no change) 1 in 2 months
A7010 * + Corrugated tubing, disposable, used with large volume nebulizer, 100 ft Taxable (no change) 1 in 2 months
A7012 * + Water collection device, used with large volume nebulizer Taxable (no change) 2 per month
A7013 * + Filter, disposable, used with aerosol compressor or ultrasonic generator Taxable (no change) 2 per month
A7016 * + Dome and mouthpiece, used with small volume ultrasonic nebulizer Taxable (no change) 2 per year
B4035 * + ^ Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape Taxable 31 per month
E0574 Ultrasonic/electronic aerosol generator with small volume nebulizer Taxable (no change) 1 in 5 years
S8186 * + Swivel adaptor Non-taxable (no change) 2 in 12 months

*  This code must be billed with modifier NU. Modifiers RB and RR are not allowed.
+  This code is for patient-owned equipment.
^  This code must be billed using the “from-through” (block-billing) method when billing for more than one day of service.

HCPCS code A7016 may be reimbursed only when used with code E0574. Authorization for rental of code E0574 may be granted in increments of up to three months, both for the initial authorization and for reauthorization. Authorization for purchase of code E0574 may be granted for one device every five years. Claims for code E0574 must include modifier NU, RR or RB.

HCPCS code S8186 is not covered by Medicare and should be billed to Medi-Cal directly.

HCPCS codes A4224 and A4225 are reimbursable under the Presumptive Eligibility for Pregnant Women (PE4PW) program.

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Chronic Dialysis Clinics
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Psychological Services
Rehabilitation Clinics
Vision Care
medi non hcp (1)
Audiology and Hearing Aids medi non hcp (1); tax (6–8, 10, 12, 13)
Durable Medical Equipment dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); tax (6–8, 10, 12, 13)
General Medicine
Obstetrics
Clinics and Hospitals
medi non hcp (1); presum bill (12)
Orthotics and Prosthetics dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1); tax (6–8, 10, 12, 13)
Pharmacy dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); dura inf (4, 6); dura oxy (25, 29, 30, 50, 52); mc sup (2, 8); medi non hcp (1); presum bill (12); tax (6–8, 10, 12, 13)
Therapies dura cd (9, 13, 14, 39); dura cd fre (1, 2, 5); medi non hcp (1)
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17. Medi-Cal List of Contract Drugs

The following provider manual section(s) have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs.

A summary of drugs that have been changed is shown below. For additional information, click on the link to the manual section and scroll to the page indicated or use the find feature to search for the particular drug.

Changed Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
January 1, 2020 DONEPEZIL HCL Restriction changed drugs cdl p1a (66)
January 1, 2020 FLUTICASONE PROPIONATE Administration added, restriction added drugs cdl p1b (23)
January 1, 2020 RIVASTIGMINE Restriction removed drugs cdl p1c (51)
March 1, 2020 BRINZOLAMIDE AND BRIMONIDINE TARTRATE Restriction added drugs cdl p1a (26)
March 1, 2020 BROMFENAC Restriction added drugs cdl p1a (27)
March 1, 2020 KETOROLAC TROMETHAMINE Restriction added drugs cdl p1b (49)
March 1, 2020 MOXIFLOXACIN HCL Restriction added drugs cdl p1b (78)
March 1, 2020 NEPAFENAC Restriction added drugs cdl p1c (4)
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18. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective January 1, 2020
NDC Labeler Code Contracting Company’s Name
21922 ENCUBE ETHICALS
50261 THERAPEUTICSMD
61990 APOLLO PHARMACEUTICALS USA INC.
69800 ADMA BIOLOGICS, INC.
70752 QUAGEN PHARMACUETICALS LLC
71626 MEDSTONE PHARMA LLC
71839 BE PHARMACEUTICALS INC.
72000 NABRIVA THERAPEUTICS US, INC.
72028 HARMONY BIOSCIENCES, LLC
72065 XERIS PHARMACEUTICALS, INC.
72266 FOSUN PHARMA USA
72485 ARMAS PHARMACEUTICALS INC.
72572 CIVICA, INC.
72694 SERVIER PHARMACEUTICALS LLC
 
Terminations, effective January 1, 2020
NDC Labeler Code Contracting Company’s Name
13310 AR SCIENTIFIC, INC.
20482 INSYS THERAPEUTICS, INC.
53329 MEDLINE INDUSTRIES, INC.
66663 PHARMELLE, LLC

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (6, 7, 10, 11, 14, 16, 18, 20, 21)
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19. 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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20. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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