Medi-Cal Update

Therapies | March 2019 | Bulletin 522

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1. Medi-Cal Website to Get an Updated Look and Feel

This spring, the Medi-Cal website will have an updated look and feel. All of the current content will be migrated to the new website and will be easier to access.

Benefits:

Access to transactions and the Medi-Cal Learning Portal will remain the same.

As the update of the website progresses, the Department of Health Care Services (DHCS) will provide updates on the Medi-Cal website.

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2. Notice of HIPAA Code Conversion for Physical and Occupational Therapy Services

The physical and occupational therapy services code conversion replaces non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT or HCPCS Level II national codes. HIPAA mandated these changes to billing requirements for physical and occupational therapy services.

Effective for dates of service on or after August 1, 2019, providers will bill claims using the following:

Billing Instructions and Frequently Asked Questions (FAQs) will be available soon in the Physical and Occupational Therapy Services section of the HIPAA: Code Conversions web page. Additional information for this project will publish as details are determined.

Providers are encouraged to:

Providers may request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers call (916) 636-1200. Providers calling from outside of California call the Out-of-State Provider Unit at (916) 636-1960.

For electronic claim submission questions, providers may contact the TSC at 1-800-541-5555, select option 4 for the Technical Help Desk and option 2 for Computer Media Claims (CMC).

All other questions about the physical and occupational therapy services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.

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3. Modifiers Override Medical Justification Requirement

Effective for dates of service on or after March 1, 2019, billing CPT codes 92002 – 92014 (general ophthalmological services) and 99201 – 99499 (Evaluation and Management [E&M] services) with modifier 24, 25 or 57 overrides the requirement of documenting medical justification when billed in conjunction with a surgical procedure as follows:

Modifier Description Application
24 Unrelated E&M service by the same physician or other qualified health care professional during a postoperative period Minor (follow-up days of zero or 10) or major surgical procedures (follow-up days of 90)
25 Significant, separately identifiable E&M service by the same physician or other qualified health care professional on the same day of the procedure or other service Minor (follow-up days of zero or 10) or major surgical procedures (follow-up days of 90)
57 Decision for surgery (major surgery only, day before or day of procedure) Major surgical procedures only (follow-up days of 90)

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

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Expanded Access to Primary Care Program
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (2, 3)
Chronic Dialysis Clinics
Rehabilitation Clinics
modif app (2, 3); modif used (3, 5, 11)
Clinics and Hospitals
General Medicine
Obstetrics
eval (2); modif app (2, 3); modif used (3, 5, 11); surg bil mod (9)
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4. Updated Indication and TAR Criteria for Tumor Treating Field Devices

Effective for dates of service on or after April 1, 2019, reimbursement for HCPCS code E0766 (electrical stimulation device used for cancer treatment, includes all accessories, any type) is specified for the treatment of newly diagnosed glioblastoma in patients 18 years of age and older who meet the following criteria, as described in a Treatment Authorization Request (TAR):

The initial TAR may be authorized for up to three months. Re-authorization may be granted when all of the following criteria are met:

Providers are also reminded that HCPCS code E0766 may only be rented with modifier RR, and may not be purchased as new equipment with modifier NU.

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

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
dura bil dme (1, 2, 39); dura cd fre (2)
Orthotics and Prosthetics
Therapies
dura cd fre (2)
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5. Updated Guidance for DRG Reimbursed Claims with More Than 22 Line Items

Effective retroactively for dates of service on or after June 6, 2014, diagnosis-related group (DRG) reimbursed claims that contain more than 22 lines should be divided across multiple pages and assigned a unique Claim Control Number (CCN) for each page. A Claims Inquiry Form (CIF) void must be submitted for all CCNs associated with the stay from admit through discharge to recoup any payments prior to the resubmission of a corrected claim. If all reimbursed CCNs are not voided, including CCNs with zero payment, this can cause the resubmitted claim to deny. A reimbursed claim that is not voided causes the new claim to be a duplicate of the previously reimbursed claim (Remittance Advice Details [RAD] code 010).

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

Provider Manual(s) Page(s) Updated
Part 2 cif co (4, 5)
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6. National Correct Coding Initiative Quarterly Update for April 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 April 1, 2019.

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

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7. April 2019 Medi-Cal Provider Seminar

The April Medi-Cal Provider Seminar is scheduled for April 17, 2019, at the Red Lion Hotel Redding in Redding, 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 April 3, 2019, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After April 3, 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 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. 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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9. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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