Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Maternal Care Services and CPSP Code Conversion: TAR/eTAR Policy Update

December 6, 2018

Effective for dates of service on or after April 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for maternal care services and Comprehensive Perinatal Services Program (CPSP). These codes will be replaced by HIPAA-compliant CPT Category I and HCPCS Level II national codes, used 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 billing instructions on the HIPAA: Code Conversions web page under the Maternal Care Services and CPSP heading.

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

TAR/eTAR Conversion Policy
Effective for dates of service on or after April 1, 2019, new TARs/eTARs for maternal care services and CPSP must include CPT Category I or HCPCS Level II national codes. TARs/eTARs using the HCPCS Level III local codes will only be valid for dates of service ending on or before March 31, 2019.

TARs/eTARs Previously Approved, Retroactive and Deferred
Existing TARs/eTARs 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 for dates of service authorized beyond March 31, 2019. Providers will need to submit new TARs/eTARs with the appropriate CPT Category I or HCPCS Level II national code(s) for services on or after April 1, 2019.

TARs/eTARs Submitted After April 1, 2019
All TARs/eTARs submitted on or after April 1, 2019, that require authorization beyond this date must include only CPT Category I or HCPCS Level II national codes.

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

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 TAR at any time. Providers should look for an upcoming eTAR seminar in their area and RSVP on the Provider Training Calendar web page.

Additional information for this code conversion will publish as details are determined. Providers are encouraged to watch for maternal care services and CPSP updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update provider bulletins. Providers should complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to maternal care services and CPSP.

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.