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Notice of Code Conversion for EPSDT Psychology, Mental and Behavioral Health

October 3, 2018

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health code conversion replaces non-HIPAA-compliant HCPCS Level III codes commonly referred to as local codes with HIPAA-compliant CPT Category I national codes. HIPAA mandated these changes to billing requirements for EPSDT psychology, mental and behavioral health services.

Providers will use a combination of:

  • CPT Category I codes; with a modifier;
  • Revenue codes and CPT Category I codes with a modifier;

The effective date for this code conversion will be announced at a future date.

EPSDT is a Medi-Cal benefit for individuals younger than 21 years of age who have full-scope Medi Cal eligibility. This benefit allows for periodic screenings to determine health care needs. Treatment services are provided based upon the identified health care need and diagnosis. EPSDT services include all services covered by Medi-Cal. In addition to regular Medi-Cal benefits, recipients younger than 21 years of age may receive additional medically necessary services.

Crosswalks and Frequently Asked Questions (FAQs) will be available soon. Additional information for this project will publish as details are determined.

Providers are encouraged to routinely check the Medi-Cal Update provider bulletins or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles and/or System Status Alerts.

For additional information, providers may:

  • Visit the EPSDT Services: Psychology, Mental and Behavioral Health heading of the HIPAA: Code Conversion webpage.
  • 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 from 8 a.m. to 12 p.m. Monday through Friday, except holidays.
  • Contact the Computer Media Claims (CMC) Help Desk by calling the TSC at 1-800 541 5555 and select the option Point of Service (POS), Internet, Lab Service Reservation System (LSRS) and CMC inquiries.

All other questions for the EPSDT psychology, mental and behavioral health code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.