Medi-Cal Update

Vision Care | December 2019 | Bulletin 503

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1. October 2019 HCPCS Quarterly Update: Policy Updates

The October 2019 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 an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12)
Clinics and Hospitals
General Medicine
chemo drug a-d (14, 15, 21); chemo drug e-o (2, 3, 17–19, 21–24); chemo drug p-z (15, 25, 26); inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25); ophthal (15–17, 19–22); surg integ (4, 5, 9)
Obstetrics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Rehabilitation Clinics inject an over (1, 2); inject cd list (2, 4–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 34, 35); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 5, 10, 11, 14, 15, 17, 18, 22–26); modif used (12); non ph (12, 13, 24, 25)
Pharmacy inject an over (1); inject cd list (2–6, 10, 11, 13–15); inject drug a-d (9, 10); inject drug e-h (26, 32, 33, 41, 42); inject drug i-m (12, 15–17, 23); inject drug n-r (4, 9, 13, 17, 22–24)
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2. 2020 CPT Annual Update

The 2020 updates to the Current Procedural Terminology (CPT) codes are available in the 2020 CPT 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 January 1, 2020. Please refer to the 2020 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
Clinics and Hospitals
General Medicine
cardio (9, 10); chemo an over (1); epsdt chdp school (5); eval (31); inject an over (1); inject cd list (9); medne neu (3, 4, 8); medne non (1); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); ophthal (2, 4, 10); ophthal cd (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); surg cardio (9); surg eye (1); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Obstetrics eval (31); inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); once (7); path drug (4); path micro (7); path molec (2, 64, 65); presum bill (10, 11); radi nuc (3, 4); surg bil mod (7); tar and non cd1 (4, 6); tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10); vaccine (4)
Rehabilitation Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); non ph (9–11, 24, 27); vaccine (4)
Chronic Dialysis Clinics inject an over (1); inject cd list (9); modif (3); modif app (12, 13); modif used (6, 10); vaccine (4)
Inpatient tar and non cd2 (1); tar and non cd3 (4); tar and non cd4 (7); tar and non cd6 (2–5); tar and non cd8 (2–4); tar and non cd9 (1, 2, 5–7, 9, 10)
Local Educational Agencies loc ed bil cd (8, 10, 11, 14, 22); loc ed serv nurs (5); loc ed serv physican (5); loc ed serv psych (7); modif app (12, 13)
Vision Care modif app (12, 13); modif used vc (2); pro serv (4, 11, 17, 19, 20); pro serv cd (7, 8); rates max optom (2)
Pharmacy inject an over (1); inject cd list (9); presum bill (10, 11)
AIDS Waiver Program modif (3); modif app (12, 13)
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3. Optician Services Restored as Medi-Cal Benefits

Effective for dates of service on or after January 1, 2020, optional benefit optician services, including services provided by a fabricating optical laboratory (FOL), previously eliminated as part of the optional benefits exclusion are reinstated as Medi-Cal benefits for eligible full-scope Medi-Cal recipients 21 years of age or older.

Effective for dates of service on or after January 1, 2020, optical providers in all counties, including San Luis Obispo, San Mateo and Santa Barbara, are limited to billing the following CPT codes 92340, 92341, 92342, 92352 or 92353 for dispensing of ophthalmic lenses fabricated by Prison Industry Authority (PIA) optical laboratories for eligible Medi-Cal recipients.

Effective for dates of service on or after January 1, 2020, the Medi-Cal contracted FOL bills for lens fabrication for all counties, including San Luis Obispo, San Mateo and Santa Barbara, using the appropriate HCPCS codes.

All optical providers will use PIA optical laboratories to fabricate lenses.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Chiropractic
Inpatient Services
Long Term Care
opt ben exc (1, 2, 4, 11, 14, 16)
AIDS Waiver Program
Chronic Dialysis Clinics
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Heroin Detoxification
Orthotics and Prosthetics
medi non hcp (4)
Audiology and Hearing Aids
Durable Medical Equipment
Medical Transportation
Obstetrics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
medi non hcp (4); opt ben exc (1, 2, 4, 11, 14, 16)
Clinics and Hospitals
General Medicine
medi non hcp (4); ophthal cd (1); opt ben exc (1, 2, 4, 11, 14)
Vision Care contact lens (1, 5, 7); eye app (1, 2, 6, 7, 9, 10); eyeglass fram (1, 2, 5); eyeglass lens (1, 2, 4, 5, 7–9, 11); eyeglass lens ex (2); low vision (1, 2, 4); medi non hcp (4); modif used vc (1); opt ben exc (1, 2, 4, 11, 14, 16); pia (1, 2); pia code dir (1, 2); pia frm comp (1); pro serv (1); pro serv cd (1); rates max disp (1); rates max eye app (1); rates max optom (1); tar comp vc (1, 3)
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4. Podiatry Services Restored as Medi-Cal Covered Benefits

Effective for dates of service on or after January 1, 2020, podiatry services previously eliminated as part of the optional benefits exclusion are reinstated as full Medi-Cal benefits.

In addition, Welfare and Institutions (W&I) code, Section 14133.07 was recently amended to remove two visit limit and to remove the same TAR requirements for services by podiatrists as for physicians and surgeons.

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
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Inpatient Services
Long Term Care
Medical Transportation
Obstetrics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
opt ben exc (1–4, 6, 7, 13)
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5. Audiology and Speech Therapy Services Restored as Medi-Cal Benefits

Effective for dates of service on or after January 1, 2020, audiology and speech therapy services previously eliminated as part of the optional benefits exclusion are reinstated as full Medi-Cal benefits.

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

Provider Manual(s) Page(s) Updated
Chiropractic
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Inpatient Services
Long Term Care
Medical Transportation
Obstetrics
Pharmacy
Psychological Services
Vision Care
opt ben exc (1–4, 6–8, 13, 16–18)
Audiology and Hearing Aids
Adult Day Health Care Centers
Rehabilitation Clinics
Therapies
audio (1, 3, 6); opt ben exc (1–4, 6–8, 13, 16–18); speech (1)
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6. National Correct Coding Initiative Quarterly Update for January 2020

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 January 1, 2020.

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

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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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