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Audiology/EPSDT Audiology/Speech Therapy Code Conversion Billing Instructions

February 5, 2019

Effective for dates of service on or after June 1, 2019, the HCPCS Level III local codes for audiology, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) audiology and speech therapy will be discontinued. National HIPAA-compliant CPT® or HCPCS Level II codes will replace the local codes on audiology, EPSDT audiology and speech therapy claims. Providers submitting UB-04 claim forms or ANSI 837I transactions must bill revenue codes in addition to the national procedure codes. The Audiology, EPSDT Audiology and Speech Therapy Code Conversion Crosswalk is available for reference.

New Treatment Authorization Requests (TARs)/electronic TAR (eTARs) and Service Authorization Requests (SARs)/electronic SARs (eSARs) for audiology and speech therapy services must include CPT® or HCPCS Level II national codes for dates of service on or after June 1, 2019. TARs and SARs using HCPCS Level III local codes will be valid only for dates of service on or before May 31, 2019.

Existing TARs/eTARs and SARs/eSARs with HCPCS Level III local codes, regardless of status (approved, retroactive or deferred), will be invalid and providers will need to end-date TARs/eTARs and SARs/eSARs for dates of service authorized beyond May 31, 2019. Providers will need to submit new TARs/eTARs and SARs/eSARs with the appropriate CPT® or HCPCS Level II national code(s) for services on or after June 1, 2019.

If the submitted TAR, eTAR, SAR or eSAR is for the purpose of updating the codes for the same authorization period, it will not be reviewed for medical necessity. Updated manual pages containing this policy will be released in a future Medi-Cal Update.