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New TAR/SAR Policy for EPSDT Psychology, Mental & Behavioral Health Services

May 6, 2019

Effective for dates of service on or after August 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services. These codes will be replaced by HIPAA-compliant CPT national codes 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 crosswalk on the EPSDT Services: Psychology, Mental and Behavioral Health dropdown of the HIPAA: Code Conversions web page.

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the following instructions:

TAR/eTAR Conversion Policy
Effective for dates of service on or after August 1, 2019, new TARs/eTARs for EPSDT psychology, mental and behavioral health services must include CPT national codes. TARs/eTARs using HCPCS Level III local codes will only be valid for dates of service on or before July 31, 2019.

TARs/eTARs Previously Authorized with Through Dates Beyond July 31, 2019
TARs/eTARs with service “from” and “through” dates on or before July 31, 2019, should be submitted using HCPCS Level III local codes. TARs/eTARs authorized with “through” dates beyond July 31, 2019, must be end dated, and a new TAR/eTAR should be submitted with the appropriate CPT national code(s) to cover any remaining service period on or after August 1, 2019.

TARs/eTARs Submitted After August 1, 2019
All TARs/eTARs submitted on or after August 1, 2019, that require authorization beyond this date must include only CPT national codes.

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

Guidelines for TAR/eTAR submissions are located in the Part 1 provider manual.

SAR/eSAR Conversion Policy
Effective for dates of service on or after August 1, 2019, new SARs/eSARs for EPSDT psychology, mental and behavioral health services must include CPT national codes. SARs/eSARs using the HCPCS Level III local codes will only be valid for dates of service on or before July 31, 2019.

SARs/eSARs Previously Authorized with Through Dates Beyond July 31, 2019
SARs/eSARs with service “from” and “through” dates on or before July 31, 2019, should be submitted using HCPCS Level III local codes. SARs/eSARs authorized with “through” dates beyond July 31, 2019, must be end dated, and a new SAR/eSAR should be submitted with the appropriate CPT national code(s) to cover any remaining service period on or after August 1, 2019.

SARs/eSARs Submitted On or After August 1, 2019
All SARs/eSARs submitted on or after August 1, 2019, that require authorization beyond this date must include only CPT national codes.

Attachments are now accepted on eSARs. California Children's Services (CCS) and Genetically Handicapped Persons Program (GHPP) 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.

Additional information for this code conversion will publish as details are determined.

Providers are encouraged to watch for EPSDT psychology, mental and behavioral health 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) Subscriber Form to receive timely notifications related to EPSDT psychology, mental and behavioral health services.

Providers may also 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. Providers calling from outside of California can contact TSC at (916) 636-1200.