Medi-Cal Update

Pharmacy | May 2018 | Bulletin 919

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1. A New Way to Subscribe – Contact Medi-Cal Subscription Service Representatives

Medi-Cal is committed to keeping you up-to-date on the latest Medi-Cal news and policy updates.

The Medi-Cal Subscription Service (MCSS) is a free service that provides subscribers with personalized email notifications for urgent, high-impact announcements and monthly news/policy updates as they post to the Medi-Cal website.

Providers can now contact MCSS representatives directly at MCSSCalifornia@conduent.com to subscribe and for assistance with managing subscriptions. Subscribing is simple and free!

If you have not yet subscribed to MCSS, Medi-Cal encourages you to utilize one of the following two methods to subscribe.

To subscribe by email:

  1. Download the linked MCSS Subscriber Form

  2. Enter your name, email address, ZIP code and subscriber type in the appropriate fields

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Attach your completed form to an email and send to MCSSCalifornia@conduent.com

To subscribe online:

  1. Go to the MCSS Subscriber Form page on the Medi-Cal website

  2. Enter your email address and ZIP code, and select a subscriber type from the drop-down menu

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

  4. Click “Subscribe Now” at the bottom of the page

After the form has been received, 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, visit the MCSS Help page.

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2. 2018 Update to PE4PW Income Eligibility Guidelines

Effective January 1, 2018, through December 31, 2018, Presumptive Eligibility for Pregnant Women (PE4PW) providers must use the following income eligibility guidelines to make PE4PW determinations. Providers should disregard all previous PE4PW income eligibility guideline charts.

PE4PW Income Eligibility Guidelines
Effective January 1, 2018, through December 31, 2018
Number of Persons in Family 213 Percent
Monthly Income
213 Percent
Annual Income
2 $2,922 $35,060
3 $3,689 $44,262
4 $4,456 $53,463
5 $5,223 $62,665
6 $5,989 $71,867
7 $6,756 $81,068
8 $7,523 $90,270
9 $8,290 $99,471
10 $9,057 $108,673
11 $9,823 $117,875
12 $10,590 $120,076
For family units of more than 12 members, for each additional member, add: $767 $9,202

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
presum (4)
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3. Modifiers Added or Revised for Select Oxygen System Codes

Effective for dates of service on or after April 1, 2018, modifiers for select oxygen system HCPCS codes have been added or revised as part of the HCPCS quarterly updates.

As presented in the following table, new modifiers QA, QB and QR have been added as approved modifiers, and the long descriptors for current modifiers QE, QF and QG have been revised:

Modifier Description
QA Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than one liter per minute (LPM)
QB Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds four LPM and portable oxygen is prescribed
QE Prescribed amount of stationary oxygen while at rest is less than one LPM. The reimbursement amount is reduced by 50 percent
QF Prescribed amount of stationary oxygen while at rest exceeds four LPM and portable oxygen is prescribed
QG Prescribed amount of stationary oxygen while at rest is greater than four LPM
QR Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds four LPM

These modifiers are billable only with the following HCPCS codes:

HCPCS Code Description
E0424 Stationary compressed gaseous oxygen system, rental; includes container, contents, regulator; flowmeter, humidifier, nebulizer, cannula or mask, and tubing
E0439 Stationary liquid oxygen system, rental; includes container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, & tubing
E1390 Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate
E1391 Oxygen concentrator, dual delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each

No action is required of providers. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC).

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Rehabilitation Clinics
Therapies
Vision Care
modif app (13)
Durable Medical Equipment dura bil oxy (16–19); modif app (13)
Pharmacy dura bil oxy (16–19)
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4. Corrections to 2018 CPT-4/HCPCS Annual Update

A previously published Medi-Cal Update added, changed and deleted CPT-4 and HCPCS codes for the 2018 annual update, effective February 1, 2018. Updates to this policy are as follows:

CPT-4 code 90750 (zoster [shingles] vaccine [HZV], recombinant, subunit, adjuvanted, for intramuscular use) is reimbursable for recipients 50 years of age and older.

The correct policy is reflected in the following PDF document:

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
immun (19)
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5. Updated Reimbursement Rates for Select DME Codes

Effective retroactively for dates of service on or after October 1, 2017, the rental and/or purchase reimbursement rates for the following Durable Medical Equipment (DME) codes are updated:

E0140 E1020 E2228 K0044 K0070
E0149 E1028 E2368 K0045 K0071
E0197 E2206 E2369 K0046 K0072
E0955 E2220 E2370 K0047 K0073
E0967 E2221 E2375 K0050 K0077
E0985 E2222 K0042 K0051 K0098
E0995 E2224 K0043 K0052  

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

For more information, providers may refer to the Medi-Cal Rates page on the Medi-Cal website.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Orthotics and Prosthetics
Pharmacy
Therapies
dura cd (4, 6, 23, 25, 28–30, 33, 35)
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6. Updates to the List of Contracted Ostomy Supplies

Effective for dates of service on or after June 1, 2018, products by ConvaTec and Genairex are added to the List of Contracted Ostomy Supplies.

Effective for dates of service on or after August 1, 2018, certain products by ConvaTec are deleted from the List of Contracted Ostomy Supplies and are no longer reimbursable. The maximum acquisition cost (MAC) for products deleted from the list is no longer guaranteed by the manufacturer.

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7. Frequency Limit Corrections for Orthotic Codes

Effective retroactively for dates of service on or after July 1, 2015, frequency limits for HCPCS codes L2200 (addition to lower extremity, limited ankle motion, each joint), L2210 (addition to lower extremity, dorsiflexion assist [plantar flexion resist], each joint) and L2220 (addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint) have been modified and are reimbursable twice in 12 months. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC) for services provided on or after July 1, 2015.

Effective for dates of service on or after June 1, 2018, the frequency limit for HCPCS code A5500 (for diabetics only, fitting [including follow-up], custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe) is reimbursable once in 12 months.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Therapies
ortho cd fre1 (1, 2)
Orthotics and Prosthetics
Pharmacy
ortho (19); ortho cd fre1 (1, 2)
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8. ICD-10-CM Diagnosis Codes Updated for Removable Foot Inserts

Effective for dates of service on or after June 1, 2018, ICD-10-CM diagnosis codes E10.40, E10.41 and G12.23 – G12.25 are billable with HCPCS code L3000 (foot, insert, removable, molded to patient model, ‘UCB’ type, Berkeley shell, each). Additionally, the following ICD-10-CM diagnosis codes are no longer billable with HCPCS code L3000:

E10.65 M20.5X1 – M20.5X9 M21.40 – M21.42 M25.771 – M25.776
G57.60 – G57.62 M21.071 – M21.079 M21.6X1 – M21.6X9 M76.60 – M76.829
M05.241 M21.171 – M21.179 M21.961 – M21.969 M77.30 – M77.52
M05.842 M21.371 – M21.379 M24.671 – M24.676 Q66.5 – Q66.89

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

Provider Manual(s) Page(s) Updated
Orthotics and Prosthetics
Pharmacy
ortho (9)
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9. June 2018 Medi-Cal Provider Training Webinars

Beginning June 5, 2018, and continuing throughout the month of June, Medi-Cal providers may participate in provider training webinars:

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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10. 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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11. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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