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Home Health Code Conversion: TAR/SAR Policy Update

April 4, 2016

Effective for dates of service on or after June 1, 2016, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes. These codes will be replaced by HIPAA-compliant revenue codes and HCPCS Level II national codes, utilized by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

To view the full code conversion, including relevant additional instructions, refer to the conversion table in the Correction: Home Health Conversion and Billing Instructions article of a previous Medi-Cal Update.

Providers should prepare and submit Treatment Authorization Requests (TARs) according to the following instructions:

TAR Conversion Policy for Previously Approved, Retroactive and Deferred TARs
All TARs with HCPCS Level III local home health codes, regardless of status (approved, retroactive or deferred), will be end-dated for dates of service on or after June 1, 2016. Providers are encouraged to submit new TARs or electronic TARs (eTARs) with the appropriate HCPCS Level II national code(s) prior to June 1, 2016.

TARs Submitted After June 1, 2016
All TARs and eTARs submitted on or after June 1, 2016, that require authorization beyond this date must include only HCPCS Level II national codes.

Providers are strongly encouraged to use eTARs. Provider benefits when using the eTAR include no mail delays or postage, money savings and a quicker response time. Additionally, eTARs allow providers to check the status of their TAR at any time. For additional information, providers should look for an upcoming eTAR seminar in their area or call the Telephone Service Center at 1-800-541-5555.

SAR Conversion Policy
Effective for dates of service on or after June 1, 2016, new Service Authorization Requests (SARs) for home health services must include HCPCS Level II national codes.

SARs Submitted After May 31, 2016
California Children’s Services (CCS)/Genetically Handicapped Persons Program (GHPP) providers should review their home health SARs that extend beyond May 31, 2016. For those SARs, providers must submit a new SAR with the appropriate HCPCS Level II national code(s) to cover any remaining service period after May 31, 2016.

SARs Previously Authorized with Through Dates Beyond May 31, 2016
Effective for dates of service on or after June 1, 2016, SARs authorized with through dates beyond May 31, 2016, must be end-dated. At the same time, providers should request existing SARs with the HCPCS Level III local codes be end-dated effective May 31, 2016.

SARs Submitted After June 1, 2016
Effective for dates of service on or after June 1, 2016, providers may begin requesting SARs with HCPCS Level II national codes. SARs using the HCPCS Level III local codes may be submitted only for dates of service ending on or before May 31, 2016.

SARs with HCPCS Level III local codes received after May 31, 2016, may be denied. Providers may need to resubmit SARs with the appropriate HCPCS Level II national codes.