Medi-Cal Update

Therapies | December 2018 | Bulletin 519

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1. 2019 CPT Annual Update

The 2019 updates to the Current Procedural Terminology (CPT) codes are available in the 2019 CPT Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

For Specialty Programs, current or future benefits for updated CPT codes are reflected in the following PDF documents:

The code additions, changes and deletions are effective for dates of service on or after January 1, 2019. Please refer to the 2019 CPT code book for complete descriptions of these codes.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
Long Term Care
Medical Transportation
Therapies
Vision Care
opt ben exc (7)
Chronic Dialysis Clinics inject cd list (9); modif used (4)
Clinics and Hospitals
General Medicine
anest (13); cardio (8–10); eval (16, 22, 28, 29); ev woman (21, 22, 34, 35); inject cd list (9); modif used (4); non ph (9, 10, 23, 24); once (6, 7); opt ben exc (7); path molec (3–15, 19–22, 25–27, 30–36, 39, 40, 46, 60, 61); presum bill (10); radi (3); radi dia (9, 24); radi dia ult (4); rates max (5); spec (2); surg bil mod (7, 8); surg nerv (4, 5); surg urin (3, 6); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Inpatient Services opt ben exc (7); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Local Educational Agency loc ed bil cd (7); loc ed bil ex (12, 14); loc ed serv psych (6)
Obstetrics anest (13); eval (16, 22, 28, 29); ev woman (21, 22, 34, 35); inject cd list (9); modif used (4); non ph (9, 10, 23, 24); once (6, 7); opt ben exc (7); path molec (3–15, 19–22, 25–27, 30–36, 39, 40, 46, 60, 61); presum bill (10); radi (3); radi dia (9, 24); radi dia ult (4); rates max (5); surg bil mod (7, 8); surg urin (3, 6); tar and non cd1 (1); tar and non cd2 (1, 4); tar and non cd3 (5, 7, 8); tar and non cd4 (1, 4); tar and non cd5 (1, 4); tar and non cd6 (3, 4); tar and non cd7 (2, 3); tar and non cd8 (1, 4); tar and non cd9 (4, 6–9)
Pharmacy inject cd list (9); opt ben exc (7); presum bill (10)
Psychological Services opt ben exc (7); psychol (4–7, 9); psychol cd (2); spec (2)
Rehabilitation Clinics inject cd list (9); modif used (4); non ph (9, 10, 23, 24); opt ben exc (7)
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2. October 2018 HCPCS Quarterly Update: Policy Updates

The October 2018 updates to the Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the Quarter 4 HCPCS Policy (Medi-Cal) PDF. Only those codes representing Medi-Cal benefits effective October 1, 2018, are included in the list of updates.

Please refer to the 2018 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
Chronic Dialysis Clinics inject cd list (5, 6, 13); inject drug a-d (52); inject drug e-h (3, 16–18)
Clinics and Hospitals
General Medicine
chemo drug e-o (6–8); chemo drug p-z (4); inject cd list (5, 6, 13); inject drug a-d (52); inject drug e-h (3, 16–18); non ph (12, 13); ophthal (16)
Durable Medical Equipment dura bil wheel (19); dura cd (28)
Orthotics and Prosthetics
Therapies
dura cd (28)
Obstetrics inject cd list (5, 6, 13); inject drug a-d (52); inject drug e-h (3, 16–18); non ph (12, 13)
Pharmacy dura bil wheel (19); dura cd (28); inject cd list (5, 6, 13); inject drug a-d (52); inject drug e-h (3, 16–18)
Rehabilitation Clinics inject cd list (5, 6, 13); inject drug a-d (52); inject drug e-h (3, 16–18); non ph (12, 13)
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3. Sign Language Interpreter Services Code Conversion Policy Overview

Effective for dates of service on or after January 1, 2019, sign language interpreter services currently billed using HCPCS Level III local codes will be converted to a specified HCPCS Level II national code.

Providers submitting claims with dates of service on or after January 1, 2019, must include the appropriate HIPAA-compliant HCPCS Level II national code described in the Sign Language Interpreter Services Crosswalk published October 2018.

For dates of service on or after January 1, 2019, HCPCS Level III local codes Z0324, Z0326, Z0328 and Z0329 will be discontinued, and any claims submitted with these codes will be denied. HCPCS Level III local codes Z0324 and Z0326 will be replaced by HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes) and revenue code 0969 (other professional fees) for UB-04 claim forms or ANSI 837I transactions.

Modifier code HM (less than bachelor degree level) will be applicable when billing for sign language interpreter services for dates of service on or after January 1, 2019. Modifier code HM is used to denote that the rendering provider is a certified sign language interpreter.

Provider Resources
Providers should refer to the Miscellaneous Services section of the HIPAA: Code Conversions web page for a complete list of sign language interpreter services code conversion resources.

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

Provider Manual(s) Page(s) Updated
Acupuncture
Adult Day Health Care Centers
Chiropractic
Heroin Detoxification
Hospice Care Program
Inpatient Services
Long Term Care
Multipurpose Senior Services Program
Pharmacy
Psychological Services
sign (3)
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
modif app (11); modif used (12); non ph (11, 24); sign (3)
Chronic Dialysis Clinics modif app (11); modif used (12); sign (3)
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (11); sign (3)
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4. Sign Language Interpreter Services Code Conversion Reminder

The sign language interpreter services code conversion will replace HCPCS Level III local codes, commonly referred to as local codes, with HIPAA-compliant HCPCS Level II national codes. This billing requirement for sign language interpreter services is mandated by HIPAA and is effective for claims with dates of service on or after January 1, 2019.

For claims with dates of service on or after January 1, 2019, the sign language interpreter services code conversion will be replacing HCPCS Level III local codes Z0324 and Z0326 with HCPCS Level II national code T1013 (sign language or oral interpretive services, per 15 minutes).

As of January 1, 2019, HCPCS Level III local codes Z0328 and Z0329 used to bill for sign language interpreter services will no longer be reimbursable.

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

Providers are encouraged to watch for sign language interpreter service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to sign language interpreter services.

For additional information, providers may:

Questions regarding the sign language interpreter services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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5. 2019 Medi-Cal Provider Training Schedule

The 2019 Medi-Cal provider training schedule is now available. Providers can access Medi-Cal training information and registration details by clicking on the Outreach & Education slideshow area of the Medi-Cal website homepage or by visiting the Training Calendar web page of the Medi-Cal Learning Portal (MLP).

Training Date Webinar or Seminar Location Address
January 2 – 31 Webinar Information posted on the Medi-Cal website
February 13 – 14 Seminar Concord
Crowne Plaza
45 John Glenn Drive
Concord, CA  94520
March 13 – 14 Seminar Ontario
Ontario Airport Hotel & Conference Center
700 North Haven Ave.
Ontario, CA  91764
April 17 Seminar Redding
Red Lion Hotel Redding
1830 Hilltop Drive
Redding, CA  96002
May 15 – 16 Seminar Escondido
California Center For The Arts
340 N. Escondido Blvd.
Escondido, CA  92025
June 4 – 27 Webinar Information to be posted on the Medi-Cal website
July 17 – 18 Seminar Sacramento
Sheraton Grand Sacramento Hotel
1230 J Street
Sacramento, CA  95814
August 14 – 15 Seminar Long Beach
Long Beach Marriott
4700 Airport Plaza Drive
Long Beach, CA  90815
September 17 – 18 Seminar Visalia
Visalia Convention Center
303 E. Acequia Ave.
Visalia, CA  93291
October 29 – 30 Seminar Pasadena
Pasadena Convention Center
300 E. Green Street
Pasadena, CA  91101
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6. January 2019 Medi-Cal Provider Training Webinars

Beginning January 2, 2019, and continuing throughout the month of January, 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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7. February 2019 Medi-Cal Provider Seminar

The February Medi-Cal provider seminar is scheduled for February 13 – 14, 2019, at the Crown Plaza in Concord, 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 DHCS 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 January 30, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After January 30, 2019, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks 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 representative.

Providers are encouraged to bookmark the Provider Training web page and refer to it often for current seminar information.

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8. 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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9. 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 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:



Note:

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