Medi-Cal Update

Psychological Services | October 2018 | Bulletin 517

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1. Notice of Code Conversion for EPSDT Psychology, Mental and Behavioral Health

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health code conversion replaces non-HIPAA-compliant HCPCS Level III codes commonly referred to as local codes with HIPAA-compliant CPT Category I national codes. HIPAA mandated these changes to billing requirements for EPSDT psychology, mental and behavioral health services.

Providers will use a combination of:

The effective date for this code conversion will be announced at a future date.

EPSDT is a Medi-Cal benefit for individuals younger than 21 years of age who have full-scope Medi Cal eligibility. This benefit allows for periodic screenings to determine health care needs. Treatment services are provided based upon the identified health care need and diagnosis. EPSDT services include all services covered by Medi-Cal. In addition to regular Medi-Cal benefits, recipients younger than 21 years of age may receive additional medically necessary services.

Crosswalks and Frequently Asked Questions (FAQs) will be available soon. Additional information for this project will publish as details are determined.

Providers are encouraged to routinely check the Medi-Cal Update provider bulletins or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles and/or System Status Alerts.

For additional information, providers may:

All other questions for the EPSDT psychology, mental and behavioral health code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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2. EPSDT Psychology, Mental and Behavioral Health Code Conversion Billing Instructions

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health HCPCS level III local codes Z5800, Z5814, Z5816 and Z5820 will be discontinued. Codes Z5814, Z5816 and Z5820 will be replaced by national HIPAA-compliant CPT Category I codes. The HIPAA-compliant CPT Category I codes will be required on EPSDT psychology, mental and behavioral health claims. Providers submitting UB-04 claim forms or ANSI 837I transactions must bill revenue codes in addition to the national procedure codes.

The effective date for this code conversion will be announced at a future date.

See the EPSDT Psychology, Mental and Behavioral Health Code Conversion Crosswalk for more information. Updated manual pages will be released in a future Medi-Cal Update.

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3. HIPAA Notice of Code Conversion for Sign Language Interpreter Services

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324 and Z0326 for sign language interpreter services will be replaced with HIPAA-compliant national HCPCS Level II code T1013. HCPCS Level III local codes Z0328 and Z0329 will be terminated.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility required by law to provide sign language interpreter services.

The Sign Language Interpreter Services Code Conversion Crosswalk and additional information for this project will publish as details are determined.

Providers are encouraged to routinely check the Medi-Cal Update bulletin or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles, and/or System Status Alerts.

For additional information, providers may:

All other questions for the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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4. Sign Language Interpreter Code Conversion Billing Instructions

Effective for dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324, Z0326, Z0328 and Z0329 for sign language interpreter services will be discontinued. Codes Z0324 and Z0326 will be replaced by national HIPAA-compliant HCPCS Level II code T1013. HCPCS Level II national code T1013 will be required to bill sign language interpreter services. Providers submitting UB-04 claim forms or ANSI 837I transactions must bill revenue codes in addition to national procedure codes. The Sign Language Interpreter Services Code Conversion Crosswalk is available for reference.

Sign language interpreter services are a benefit to facilitate effective communication with deaf or hearing-impaired Medi-Cal recipients. Sign language interpreter services are not covered for recipients receiving these services in a health facility that is required by law to provide sign language interpreter services.

Updated manual pages will be released in a future Medi-Cal Update.

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5. Sign Language Interpreter Services Code Conversion: Frequently Asked Questions

Effective for dates of service on or after January 1, 2019, the sign language interpreter services code conversion replaces HCPCS Level III local codes with HIPAA-compliant HCPCS Level II national billing codes. Providers are encouraged to familiarize themselves with the Sign Language Interpreter Services Code Conversion: Frequently Asked Questions.

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6. Drug Products Requiring SAR Added for CCS and GHPP

The following drug products are added to the pharmacy list of drugs and nutritional products that require a separate Service Authorization Request (SAR) for the California Children's Services (CCS) program and Genetically Handicapped Persons Program (GHPP).

Retroactive
Effective Date
Drug Product
August 1, 2017 Tisagenlecleucel

Triptorelin pamoate
October 1, 2017 Axicabtagene ciloleucel
November 1, 2017 Emicizumab-KXWH

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

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Clinics and Hospitals
Chronic Dialysis Clinics
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational 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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7. Electronic SAR Now Supports Attachments

California Children’s Services (CCS) and Genetically Handicapped Persons Program (GHPP) providers can now submit Service Authorization Requests (SARs) in an electronic format (eSAR) with attachments. Attachments must be in format of PDF, JPG or TIF. Attachments must be less than 15 megabytes (MB) in size, with the sum of all attachments being less than 150 MB. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit eSARs, providers must:

Then, select one of the available options to submit:

Registered providers and clearinghouses can complete and submit the eSAR requests on behalf of the providers and facilities in their network.

Paper SAR submissions remain an option for low-volume SAR providers or submitters who may have technical limitations or practical reasons to do so.

Providers interested in learning more about eSAR submissions should contact the CMS Net Help Desk at cmshelp@dhcs.ca.gov or 1-866-685-8449 for helpful guidance and additional information.

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

Provider Manual(s) Page(s) Updated
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 Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child sar (12); genetic (4)
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8. National Correct Coding Initiative Quarterly Update for October 2018

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after October 1, 2018.

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

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9. 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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10. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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