The 2019 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2019 HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after February 1, 2019. Providers should refer to the 2019 HCPCS Level II code book for complete descriptions of these codes.

Providers should refer to the HCPCS Annual Update page for ongoing updates.

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

Provider Manual(s)	Page(s) Updated
AIDS Waiver Program Heroin Detoxification Home Health Agencies/Home and Community-Based Services Hospice Care Program Medical Transportation Psychological Services Therapies Vision Care	medi non hcp (2)
Audiology and Hearing Aids	hear aid bill (3, 4); hear aid cd (1, 3); medi non hcp (2); tax (10)
Chronic Dialysis Clinics	inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12)
Clinics and Hospitals General Medicine	chemo an over (2); chemo drug a-d (3, 8, 23, 24, 31); chemo drug e-o (7, 8, 18, 21); chemo drug p-z (9–12, 19, 20); inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); medne tele (5); modif used (12); non ph (12–14, 25–27); once (1); ophthal (16); radi dia ult (3); radi onc (7–9); surg eye (14); surg integ (5); surg nerv (3)
Durable Medical Equipment Orthotics and Prosthetics	medi non hcp (2); tax (10)
Obstetrics	inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27); once (1); radi dia ult (3); radi onc (7–9)
Pharmacy	inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); tax (10)
Rehabilitation Clinics	inject cd list (2–11, 13–16); inject drug a-d (14, 15, 37); inject drug e-h (2–5, 8, 23, 24, 30, 31); inject drug i-m (1, 2, 15–17); inject drug n-r (9–12, 17); inject drug s-z (14, 15, 20, 21); medi non hcp (2); modif used (12); non ph (12–14, 25–27)

In November 2018, policy information and resources were published regarding the audiology, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) audiology and speech therapy code conversion. The policy effective date for this code conversion has changed and will be provided at a later date.

All materials published regarding the audiology, EPSDT audiology and speech therapy code conversion will be updated to reflect this change.

Providers are encouraged to visit the Audiology/EPSDT Audiology/Speech Therapy section of the HIPAA: Code Conversions web page for updates and additional resources.

Effective immediately, providers rendering Pediatric Day Health Care (PDHC) or Private Duty Nursing (PDN) services under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit must indicate so on their Treatment Authorization Requests (TARs).

For electronic TARs (eTARs), providers must select the appropriate special handling code on the Patient Information page:

• EPSDT PDHC


• EPSDT PDN

For paper 50-1 TARs, providers must include “EPSDT PDHC” or “EPSDT PDN” in the Specific Services Requested field (Box 10A).

For additional TAR information, contact: PDNinquiries@dhcs.ca.gov.

Any email containing protected health information (PHI) or personal information (PI) should be sent via secure or encrypted email.

Note:

California Children’s Services’ (CCS) Service Authorization Requests (SARs) are not affected by this update.

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 Inpatient Services Medical Transportation Obstetrics Orthotics and Prosthetics Psychological Services Rehabilitation Clinics Therapies Pharmacy	tar comp (8); tar field (2); cal child (3)
Adult Day Health Care Centers Heroin Detoxification Hospice Care Program	tar comp (8); tar field (2)
Long Term Care	tar field (2)
Home Health Agencies/Home and Community-Based Services	ped (3); tar comp (8); tar field (2); cal child (3)
Local Educational Agency Vision Care	cal child (3)

Effective retroactively for dates of service on or after December 1, 2008, HCPCS code J9065 (injection, cladribine, per 1 mg) is a Medi-Cal benefit.

Cladribine is indicated for the treatment of recipients of all ages with neoplastic conditions such as hairy cell leukemia.

The recommended dosage varies depending on the recipient's age, treatment condition, and response to therapy and may range from 0.09 – 1.4 mg/kg/day given as an intravenous infusion from between one to seven days per cycle. If the dosage exceeds the billing limitation of 25 mg per day, a Treatment Authorization Request (TAR) is required for reimbursement.

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

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

Provider Manual(s)	Page(s) Updated
Chronic Dialysis Clinics Pharmacy	inject cd list (4)
Clinics and Hospitals General Medicine	chemo drug a-d (22); inject cd list (4); non ph (26)
Obstetrics Rehabilitation Clinics	inject cd list (4); non ph (26)

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 January 1, 2019.

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

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective January 1, 2019
NDC Labeler Code	Contracting Company's Name
00254	PAR PHARMACEUTICAL INC.
10148	COTHERIX, INC.
16781	ONSET DERMATOLOGICS LLC
24689	APNAR PHARMA LP
42192	ACELLA PHARMACEUTICALS, LLC
46017	MYLAN CONSUMER HEALTHCARE, INC.
50228	SCIEGEN PHARMACEUTICALS, INC.
52856	PTC THERAPEUTICS, INC.
61145	REPHARM LLC
69292	AMICI PHARMACEUTICALS LLC
69557	SCILEX PHARMACEUTICALS
70127	GREENWICH BIOSCIENCES INC.
70428	DERMIRA, INC.
70594	XELLIA PHARMACEUTICALS USA, LLC
70677	MCKESSON CORPORATION
70726	ITF PHARMA, INC.
71258	PROGENICS PHARMACEUTICALS, INC.
71336	ALNYLAM PHARMACEUTICALS, INC.
71369	AKARX, INC.
71558	INSMED INCORPORATED
71717	MEGALITH PHARMACEUTICALS INC.
71773	TETRAPHASE PHARMACEUTICALS, INC.
71779	VERASTEM, INC.
71904	AMICUS THERAPEUTICS, INC.
72126	AKCEA THERAPEUTICS, INC.
72205	NOVADOZ PHARMACEUTICALS, LLC
72245	FORTE BIO-PHARMA LLC
72511	AMGEN USA INC.

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

Provider Manual(s)	Page(s) Updated
Adult Day Health Care Centers AIDS Waiver Program Chronic Dialysis Clinics Clinics and Hospitals Expanded Access to Primary Care Program General Medicine Heroin Detoxification Home Health Agencies/Home and Community-Based Services Hospice Care Program Multipurpose Senior Services Program Obstetrics Pharmacy Rehabilitation Clinics	drugs cdl p5 (4, 5, 7–11, 13, 18–20)

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