Medi-Cal Update

Psychological Services | December 2013 | Bulletin 459

Print Medi-Cal Update
 

1. ICD-10 Transition Checklist Now Available

Providers are encouraged to read the new International Classification of Diseases, 10th Revision (ICD-10) code transition checklist available on the HIPAA: ICD-10 page of the Medi-Cal website. The checklist provides a timeline outlining the actions providers and/or submitters should be taking until the 2014 implementation date so they are ready for ICD-10 implementation. Failure to comply with ICD-10 by October 1, 2014, may result in delayed claim reimbursement. 

Medi-Cal also invites providers to take the ICD-10 Provider Readiness Survey. Please check the Medi-Cal website often for updates regarding ICD-10.

Print Article | Return to Top
 

2. Old and New CMS-1500 Claim Versions in First Quarter of 2014

Beginning January 6, 2014, the Medi-Cal claims processing system will be able to accept and process the new 02/12 version of the CMS-1500 claim form. The old 08/05 version of the CMS-1500 will continue to be accepted and processed also, but only for three months, through March 31, 2014. Beginning April 1, 2014, only claims submitted on the 02/12 version will be accepted and processed.

Information submitted in the fields of the new 02/12 version will be the same as information submitted on the old 08/05 version of the claim except for the following:

Field Description Information
17 Name of Referring Provider or
Other Source
Enter provider name to the right of the dotted line
21 Diagnosis or Nature of Illness or Injury Lines changed to alphabetical items
Eight added lines are not relevant to Medi-Cal
New ICD Ind. not yet required by Medi-Cal

Side-by-side comparisons of field changes between the 02/12 and 08/05 claim versions are available in the New CMS-1500 Medi-Cal Guide, which can be downloaded from the new Claim Form Updates page of the Medi-Cal website.

Provider Manual Update Plan
The CMS-1500 has been revised, in part, to accommodate the ICD indicator that will be required on claims in 2014 with the ICD-10-CM code rollout. Plans for releasing ICD-10 information (including CMS-1500 claim examples) to providers are still developing and subject to change. At present the approach to provider manual updates is as follows:

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

Provider Manual(s) Page(s) Updated
Acupuncture
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
General Medicine
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Therapies
cms comp (1–51)
Vision Care cms comp vc (1–30)
Print Article | Return to Top
 

3. Psychology Services Local Code Conversion

Effective for dates of service on or after January 1, 2014, HCPCS local codes for psychology services are terminated and replaced with CPT-4 codes as follows:

Deleted Codes Replacement Codes Description Suggested Revenue Codes*
X9500 90832 Psychotherapy, 30 minutes with recipient and/or family member 0914
X9502 90837 Psychotherapy, 60 minutes with recipient and/or family member 0914
X9504 90839 and 90840 Psychotherapy for crisis; first 60 minutes and each additional 30 minutes 0914
X9506 90853 Group psychotherapy (other than of a multiple-family group) 0915
X9544 99366 or 99368 Medical team conference, 30 minutes, with/without recipient and/or family present 0919

Also effective for dates of service on or after January 1, 2014, the following HCPCS local codes for psychology services are terminated with no replacements:

X9508 X9516 X9524 X9532 X9540 X9550
X9510 X9518 X9526 X9534 X9542 Z0300
X9512 X9520 X9528 X9536 X9546  
X9514 X9522 X9530 X9538 X9548  

Also effective for dates of service on or after January 1, 2014, the following CPT-4 codes are to be used according to the test performed with suggested Revenue Code 0918*:

CPT-4 codes Description
96101 Psychological testing, per hour of the psychologist's or physician's time, both face-to-face time administering tests to the recipient and time interpreting test results and preparing the report
96105 Assessment of aphasia, with interpretation and report, per hour
96110 Developmental screening, with interpretation and report, per standardized instrument form
96111 Developmental testing, with interpretation and report
96116 Neurobehavioral status exam, per hour of the psychologist's or physician's time, both face-to-face time administering tests to the recipient and time interpreting these test results and preparing the report
96118 Neuropsychological testing, per hour of the psychologist’s or physician's time, both face-to-face time administering tests to the recipient and time interpreting these test results and preparing the report
96120 Neuropsychological testing, administered by a computer, with qualified health care professional interpretation and report

* A revenue code is required when billing on a UB-04 claim form or the 837-I transaction.

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

Provider Manual(s) Page(s) Updated
General Medicine hcpcs iii (3, 4); medi non hcp (3); medne tele (1, 5); modif used (5); oth hlth cpt (2); psych (1, 3, 4); rates max (3); spec (2)
Clinics and Hospitals hcpcs iii (3, 4); medi non hcp (3); medne tele (1, 5); modif used (5); oth hlth cpt (2); psych (1, 3, 4); rates max (3); spec (2)
Obstetrics hcpcs iii (3, 4); medi non hcp (3); modif used (5); oth hlth cpt (2); rates max (3)
Psychological Services hcpcs iii (3, 4); medi non hcp (3); psychol (2–5); psychol cd (1, 2); psychol ex (2–5); spec (2)
Audiology and Hearing Aids
Medical Transportation
hcpcs iii (3, 4); medi non hcp (3); oth hlth cpt (2)
Chronic Dialysis Clinics
Rehabilitation Clinics
hcpcs iii (3, 4); medi non hcp (3); modif used (5); oth hlth cpt (2)
AIDS Waiver Program
Heroin Detoxification
Home Health Agencies/ Home and Community-Based Services
Hospice Care Program
hcpcs iii (3, 4); medi non hcp (3); oth hlth cpt (2)
Durable Medical Equipment
Orthotics and Prosthetics
Therapies
hcpcs iii (3, 4); medi non hcp (3)
Adult Day Health Care Centers
Expanded Access to Primary Care Program
Local Education Agency
Multipurpose Senior Services Program
hcpcs iii (3, 4) ; oth hlth cpt (2)
Acupuncture
Chiropractic
Inpatient Services
hcpcs iii (3, 4)
Pharmacy
Vision Care
medi non hcp (3)
Print Article | Return to Top
 

4. Psychology Services Expanded

In accordance with Senate Bill X1-1 (Hernandez, Chapter 4, Statutes of 2013), Section 28 and the Patient Protection and Affordable Care Act, effective for dates of service on or after January 1, 2014, psychology services are no longer optional benefits excluded from coverage under the Medi-Cal program.

When medically necessary, eligible Medi-Cal recipients may receive the following mental health outpatient services provided by psychologists and services provided by psychiatrists:

The following changes for psychology and psychiatry services are also noted:

Conditions that the DSM identifies as relational problems, such as couples counseling or family counseling for relational problems, are not covered.

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

Provider Manual(s) Page(s) Updated
Psychological Services opt ben exc (1, 2, 4, 6, 7, 18, 20); psychol (1–5); tar field (3)
Clinics and Hospitals
General Medicine
medne tele (1, 4, 5); opt ben exc (1, 2, 4, 6, 7, 18, 20); psych (1–5); tar field (3)
Adult Day Health Care Centers
Audiology and Hearing Aids
Durable Medical Equipment
Inpatient Services
Long Term Care
Medical Transportation
Obstetrics
Pharmacy
Rehabilitation Clinics
Therapies
opt ben exc (1, 2, 4, 6, 7, 18, 20); tar field (3)
Acupuncture
Chiropractic
Vision Care
opt ben exc (1, 2, 4, 6, 7, 18, 20)
Chronic Dialysis Clinics
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Orthotics and Prosthetics
tar field (3)
Print Article | Return to Top
 

5. CCS Program Policy Updates and Corrected RTD Address

Effective October 1, 2013, the California Children’s Services (CCS) program has updated information regarding Genetically Handicapped Persons Program (GHPP) and Newborn Hearing Screening Program (NHSP) applications and Service Authorization Request (SAR) submission guidelines. Below is a summary of the submission information for applications and SARs for GHPP and NHSP.

SCD Now Has Oversight for CMS and NHSP
Systems of Care Division (SCD) is now responsible for the implementation and oversight of the NHSP and the Children’s Medical Services (CMS) for submittal of SARs for transplant recipients younger than 21 years of age or recipients who are eligible for the GHPP.

GHPP Address Change
The address and fax number to submit SARs and GHPP applications and referral forms have changed to the following:

Department of Healthcare Services
Genetically Handicapped Persons Program
MS 8100
P.O. Box 997413
Sacramento, CA  95899-7413
Fax:  (916) 440-5318

SAR Submission
Medical supply SAR submission requirements are updated for supplies that exceed the billing limits set by Medi-Cal policy.

RTD Mailing Address Update
The mailing address for Resubmission Turnaround Document (RTD) submissions was inadvertently published with an incorrect P.O. Box and zip code in the October 2013 Medi-Cal Update and NewsFlash area.

The following is the correct mailing address:

Xerox State Healthcare, LLC
P.O. Box 15200
Sacramento CA  95851-1200

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

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Inpatient Services
genetic (1–7, 10, 11, 14, 16); newborn (1, 4); transplant (2)
Audiology and Hearing Aids
Rehabilitation Clinics
Therapies
genetic (1–7, 10, 11, 14, 16); newborn (1, 4)
Chronic Dialysis Clinics
Durable Medical Equipment
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Pharmacy
Psychological Services
Vision Care
genetic (1–7, 10, 11, 14, 16)
Print Article | Return to Top
 

6. TAR Address Update for Regionalized Services, Field Offices and Appeals

The following addresses for mailing paper Treatment Authorization Requests (TARs) have been updated.

Regionalized Services: Home Health Agency and Subacute Services
Effective September 1, 2013, TARs for Home Health Agency and Subacute services have been redirected from the San Bernardino Medi-Cal Field Office to the Los Angeles Medi-Cal Field Office. Submit all paper TARs for Home Health Agency and Subacute services to the following address:

Los Angeles Medi-Cal Field Office
MS 4513
311 South Spring Street
Los Angeles, CA  90060-0172

P.O. Box 60172
Los Angeles, CA  90060-0172

TAR Appeals
Effective October 1, 2013, submit all paper TAR appeals to the following address:

West Sacramento TAR Processing Center Appeals
820 Stillwater Road
West Sacramento, CA  95605-1630

West Sacramento TAR Processing Center
TAR Appeals
P.O. Box 13029
Sacramento, CA  95813-4029

The physical mailing address of paper TAR appeals was inadvertently omitted from the October 2013 Medi-Cal Update. The correct physical mailing address is notated above.

Paper TARs for Sacramento, San Bernardino and San Francisco Field Offices
Effective October 1, 2013, submit all paper TARs for the Sacramento, San Bernardino and San Francisco field offices to the following address:

West Sacramento TAR Processing Center
820 Stillwater Road
West Sacramento, CA  95605

P.O. Box 13029
Sacramento, CA  95813-4029

The physical mailing address of paper TARs for the Sacramento, San Bernardino and San Francisco field offices was inadvertently omitted from the October 2013 Medi-Cal Update. The correct physical mailing address is notated above.

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

Provider Manual(s) Page(s) Updated
Long Term Care subacut lev (1, 3); tar field (4, 6, 8, 9); tar submit (1); tar ltc (1)
Clinics and Hospitals
General Medicine
Pharmacy
subacut lev (1, 3); tar field (4, 6, 8, 9); tar submit (1)
Adult Day Health Care Centers
Audiology and Hearing Aids
Chronic Dialysis Clinics
Durable Medical Equipment
Heroin Detoxification
Home Health Agencies/Home and
  Community-Based Services
Hospice Care Program
Inpatient Services
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Rehabilitation Clinics
Psychological Services
Therapies
tar field (4, 6, 8, 9); tar submit (1)
Print Article | Return to Top
 

7. Updates for the ACA Increased Medicaid Payments for Primary Care Physicians

The Patient Protection and Affordable Care Act (ACA), as amended by House Resolution 4872-24 Health Care and Education Reconciliation Act of 2010, Section 1202, requires that payments to primary care physicians be increased to the Medicare equivalent for certain Evaluation and Management and Vaccine Administration services for calendar years 2013 and 2014. The following updates have been made in relation to these payment increases.

A new Managed Care Plan Attestation Download Process and Data Element Dictionary is now available. This document provides directions to Managed Care Plans (MCPs) for downloading self attestation data from the Medi-Cal website. The document includes a data element dictionary that describes the fields and formats contained in the self attestation data file. Providers may download this document from the “Downloads” section of the Affordable Care Act (ACA) page.

The Affordable Care Act – Primary Care Physician Self Attestation Form Completion Instructions have been updated to include out-of-state licenses in fields 10 and 11. The updated document is available on the ACA Increased Medicaid Payment for Primary Care Physicians page.

Please note that the following categories will not be part of the ACA interim payment process:

Note:

Once the system has been fully updated, payment for the categories referenced above will be released retroactively for dates of service on or after January 1, 2013.

Print Article | Return to Top
 

8. Notification to Medi-Cal Providers Submitting eTAR Attachments

Providers having trouble uploading Electronic Treatment Authorization Request (eTAR) attachments may be using an incompatible, old or outdated browser. It is recommended that providers continually verify and update their browser to the latest version to ensure that attachments upload successfully.

Below are browsers that are known to be compatible with eTAR and eTAR attachment applications:

This is not a comprehensive list and there may be other compatible browsers. However, the above identified browsers are most commonly utilized by providers to successfully submit eTARs and eTAR attachments. For links to free downloads of Internet Explorer and other programs, providers may visit the Web Tool Box page on the Medi-Cal website.

Providers who upload attachments using the eTAR application should follow these guidelines:

Print Article | Return to Top
 

9. Reminder: Contacting the Small Provider Billing Unit

The Small Provider Billing Unit (SPBU) program is a free, one-year, full-service billing assistance program provided by Xerox State Healthcare, LLC and the Department of Health Care Services. The program provides claim submissions of up to 100 claim lines per month.

The SPBU contact number is (916) 636-1275 and should be used only by providers who are enrolled in the SPBU program or are interested in enrolling. The SPBU program is designed to support the following:

For all other inquiries, including requesting a regional representative for billing assistance, contact the Telephone Service Center (TSC) at 1-800-541-5555.

Print Article | Return to Top
 

10. Addition of Satellite Health to End Stage Renal Disease Pilot Project

Effective for dates of service on or after January 1, 2014, Satellite Health joins VillageHealth in providing Medicare Health Maintenance Organization (HMO) functions for the End Stage Renal Disease (ESRD) Pilot Project. All existing billing instructions remain the same and are applicable to the new participating provider.

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

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
dial end (6); oth hlth (1)
Acupuncture
Adult Day Health Care Centers
AIDS Waiver Program
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
Expanded Access to Primary Care Program
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Inpatient Services
Local Educational Agency
Long Term Care
Medical Transportation
Multi-Purpose Senior Services Program
Obstetrics
Orthotics and Prosthetics
Outpatient Services
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
oth hlth (1)
Part 1 mcp spec (7–9); medicare (3)
Print Article | Return to Top
 

11. January 2014 Medi-Cal Webinars

Beginning January 7, 2014, and continuing throughout January, Xerox State Healthcare, LLC, the DHCS Fiscal Intermediary (FI) for Medi-Cal, invites providers to participate in Medi-Cal provider training webinars, which will be as follows:

All recorded webinars will be archived in the Medi-Cal Learning Portal. If providers are unable to attend a webinar, they can view it later at a more convenient time.

To view the training webinars, providers must have Internet access and create a user profile in the Medi-Cal Learning Portal. Details about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal website.

Join us online and take advantage of this exciting opportunity from Medi-Cal. Please see the table below for the dates and times of the available classes.

Date Class Name Time
1/07/2014 Recipient Eligibility 10 a.m.
1/07/2014 Share of Cost 2 p.m.
1/08/2014 eTAR 10 a.m.
1/08/2014 CMS-1500 Claim Form 2 p.m.
1/09/2014 UB-04 Claim Form 10 a.m.
1/09/2014 Claims Follow Up 2 p.m.
1/14/2014 LTC (25-1) Completion 10 a.m.
1/14/2014 LTC Crossover Claims 2 p.m.
1/15/2014 Medi-Cal Crossover Claims 10 a.m.
1/15/2014 Allied Health Common Denials 2 p.m.
1/16/2014 Long Term Care Common Denials 10 a.m.
1/16/2014 FQHC, RHC, & IHS Services 2 p.m.
1/21/2014 Surgical Modifiers Professional 10 a.m.
1/21/2014 Durable Medical Equipment 2 p.m.
1/22/2014 Inpatient/Outpatient Common Denials 10 a.m.
1/22/2014 Presumptive Eligibility 2 p.m.
1/23/2014 Obstetrics Presumptive Eligibility 10 a.m.
1/23/2014 Comprehensive Perinatal Services Program 2 p.m.
1/28/2014 Family PACT Eligibility 10 a.m.
1/28/2014 Family PACT Billing 2 p.m.
1/29/2014 Enrolling Effectively in Medi-Cal to Bill Successfully 10 a.m.
1/29/2014 Child Health & Disability Prevention 2 p.m.
1/30/2014 DRG Billing Session : Diagnosis- Related Groups 10 a.m.
1/30/2014 California Children’s Services/ Genetically Handicapped Persons Program 2 p.m.
Print Article | Return to Top
 

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

MCSS Logo

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 for urgent announcements and other updates shortly, after posting 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
  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.

Print Article | Return to Top
 

13. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

Print Article | Return to Top


Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.