Medi-Cal Update

Pharmacy | September 2017 | Bulletin 904

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1. Medi-Cal List of Contract Drugs

The following provider manual sections have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs.

A summary of drugs that have been added or 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.

Added Drugs
Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2017 FLUTICASONE FUROATE Drug added, administration added, restriction added drugs cdl p2 (7)
October 1, 2017 FLUTICASONE PROPIONATE Drug added, administration added, restriction added drugs cdl p2 (7)
October 1, 2017 SUMATRIPTAN Drug added, administration added, restriction added drugs cdl p1d (8)

Changed Drugs
Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2017 BUPRENORPHINE Restriction added drugs cdl p1a (26)
October 1, 2017 FLUTICASONE FUROATE Strength added, restriction added drugs cdl p1b (22)
October 1, 2017 FLUTICASONE PROPIONATE Strength changed, strength added, restriction changed drugs cdl p1b (23)
October 1, 2017 LINAGLIPTIN Restriction added drugs cdl p1b (56)
October 1, 2017 SUMATRIPTAN SUCCINATE Dosage changed, restriction changed, note removed, administration removed, restriction removed drugs cdl p1d (9)
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2. Medi-Cal List of Contract Drugs

The following provider manual sections have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs.

A summary of drugs that have been added or 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 Drugs
Effective Date Drug Summary of Changes Page(s) Updated
August 18, 2017 OLAPARIB Administration added, strength added drugs cdl p1c (12)
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3. Resubmission of Claims Denied for Certain Medicare Non-Covered Services

The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain claims billed with the following medical supply billing codes.


A4206 – A4209
A6021 A6266
A4212 A6022 A6402 – A6404
A4213 A6154 A6407
A4215 A6196 A6410
A4223 A6197 A6411
A4244 – A4248 A6199 A6442 – A6447
A4461 A6203 – A6224 A6453 – A6455
A4657 A6228 – A6248 A6457
A4927 A6251 – A6259 T4537
A4930 – A4932 A6261  
A6010 A6262  

Providers may resubmit claims that meet all of the following criteria:

Providers may resubmit claims adhering to the criteria above during a six-month period beginning October 16, 2017, and ending April 15, 2018.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
mc sup (5); medi non hcp (3)
AIDS Waiver Program
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
medi non hcp (3)
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4. Medical Supplies Updates: Wound Care Advanced Dressings

Effective for dates of service on or after October 1, 2017, the List of Contracted Wound Care Advanced Dressings is updated. Dressings by Molnlycke are added to the list and the end dates are removed for other dressings by Molnlycke and will be reimbursable for the following HCPCS codes:

Code Description
A6206 Contact layer, sterile, 16 sq. in. or less, each dressing
A6207 Contact layer, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A6208 Contact layer, sterile, more than 48 sq. in., each dressing
A6209 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing
A6210 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
A6211 Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
A6212 Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing
A6213 Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing
A6257 Transparent film, sterile, 16 sq. in. or less, each dressing
A6258 Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing
A6259 Transparent film, sterile, more than 48 sq. in., each dressing

Also effective for dates of service on or after October 1, 2017, L & R USA Inc products are added to the List of Contracted Wound Care Advanced Dressings for HCPCS codes A6209, A6212 and A6213.

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5. Updates to Medical Supplies Billing Codes, Units and Quantity Limits

Effective for dates of service on or after April 1, 2017, the Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet is updated. Wound care claims billed with HCPCS codes A6021 (collagen dressing, sterile, size 16 sq. in. or less, each) and A6022 (collagen dressing, sterile, size more than 16 sq. in. but less than or equal to 48 sq. in., each) are no longer limited to four Endoform dressings. Products billed with HCPCS codes A6021 and A6022 are limited to 10 dressings per wound per 27-day period, up to 90-day duration of therapy.

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6. Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)

A new DUR Educational Article titled “Alert: Online Report to the Vaccine Adverse Event Reporting System (VAERS)” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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7. 2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines

A new DUR Educational Article titled “2017 Immunization Updates: Influenza, HepA, Meningococcal, HPV, Adult Vaccines” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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