Medi-Cal Update

Pharmacy | September 2019 | Bulletin 951

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1. 2020 ICD-10-CM/PCS Codes Annual Update

Effective for dates of service on or after October 1, 2019, the Centers for Medicare & Medicaid Services (CMS) has updated ICD-10-CM and ICD-10-PCS codes for the 2020 annual ICD-10 update.

Information and downloads for these codes can be found at the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update and Family PACT Update.

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2. Financial Conflict of Interest Exception for CPAP and Bi-PAP Providers

Effective for dates of service on or after October 1, 2019, the provider who supplies a recipient with a Continuous Positive Airway Pressure (CPAP) or Bi-Level Positive Airway Pressure (Bi-PAP) unit may also be the provider who performs and/or interprets the sleep test if the sleep test is an attended facility-based polysomnogram.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
dura bil oxy (27, 31)
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3. Manual Enrollment for PE4PW is Discontinued

Effective October 31, 2018, the Department of Health Care Services (DHCS) has discontinued the manual (paper) enrollment process for the Presumptive Eligibility for Pregnant Women (PE4PW) program. Claims for services provided on or after January 1, 2019, submitted with the paper MC 263 PE Proof of Eligibility identification card are not reimbursable by Medi-Cal.

MC 263 PE For Pregnancy

If a recipient presents this type of ID for services, the provider must inform them that the ID is invalid and the recipient can locate a provider to enroll them electronically by visiting the Presumptive Eligibility for Pregnant Women page of the DHCS website.

Recipients enrolled through the electronic PE4PW web page will have a printed Immediate Need card and a record in the Med-Cal Eligibility Data System (MEDS). Providers should check eligibility before providing services.

Medi-Cal providers who provide prenatal care are encouraged to apply to become a Qualified Provider (QP) by completing the Qualified Application for Presumptive Eligibility Participation and taking the required PE4PW Computer Based Training (CBT). Information about the PE4PW program is available on the Presumptive Eligibility for Pregnant Women page of the Medi-Cal website.

QPs using the manual enrollment process must discontinue use of the paper Presumptive Eligibility for Pregnant Women Program Application (MC 263) and confidentially destroy any remaining forms.

For questions concerning enrollment, CBT and other PE4PW issues, providers may email PE@dhcs.ca.gov.

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4. Antihemophilic Factor Jivi is a Medi-Cal Benefit

Effective for dates of service on or after October 1, 2019, HCPCS code J7208 (injection, Factor VIII, [antihemophilic factor, recombinant], PEGylated-aucl, [Jivi], 1 IU), is a Medi-Cal benefit. Code J7208 may be billed with modifiers U7 and 99 for physician assistant services and SA and SB for non-physician medical practitioner services, as well as modifier UD for all providers.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Pharmacy
blood (3)
Clinics and Hospitals
General Medicine
blood (3); non ph (13, 26)
Obstetrics
Rehabilitation Clinics
non ph (13, 26)
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5. National Correct Coding Initiative Quarterly Update for October 2019

The Centers for Medicare & Medicaid Services (CMS) are scheduled to routinely release the quarterly National Correct Coding Initiative (NCCI) in Medicaid payment policy updates. These mandatory national edits will be incorporated into the Medi-Cal claims processing system and will be effective for dates of service on or after October 1, 2019.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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6. October 2019 Medi-Cal Provider Seminar

The October Medi-Cal provider seminar is scheduled for October 29 – 30, 2019, at the Pasadena Convention Center in Pasadena, California. Providers can access a class schedule for the seminar by visiting the Provider Training web 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 California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) for Medi-Cal, 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 October 15, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After October 15, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks web page 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 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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7. 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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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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