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Notice of HIPAA Code Conversion for NICU/PICU Services

November 28, 2018

The Neonatal and Pediatric Intensive Care Unit (NICU/PICU) code conversion replaces HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT Category I national codes. HIPAA mandated these changes to the billing requirements for NICU/PICU services.

For claims with dates of service on or after May 1, 2019, providers will use HIPAA-compliant CPT Category I codes with or without modifier(s).

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

Providers are encouraged to:

  • Refer to the NICU/PICU Billing Instructions for a full description of the CPT Category I national codes and modifiers.
  • Routinely check the Medi-Cal Learning Portal (MLP) Provider Training Calendar for announcements of upcoming training and webinars developed specifically for NICU/PICU services.
  • Watch for NICU/PICU updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update provider bulletins.
  • Complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to NICU/PICU services.

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, 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 NICU/PICU code conversion may be submitted via email to CAMMISCodeConversion@conduent.com