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EPSDT Psychology, Mental & Behavioral Health Code Conversion: TAR/SAR Policy

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 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) psychology, mental and behavioral health services. These codes will be replaced by HIPAA-compliant CPT Category I 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 crosswalk on the EPSDT Services: Psychology, Mental and Behavioral Health section 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 April 1, 2019, new TARs/eTARs for EPSDT psychology, mental and behavioral health services must include CPT Category I 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 beyond March 31, 2019. Providers will need to submit new TARs/eTARs with the appropriate CPT Category I 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 national codes.

Providers are strongly encouraged to use eTARs. Provider benefits when using eTARs 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. 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 appropriate Part 1 provider manual.

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

SARs/eSARs Previously Authorized with Through Dates Beyond March 31, 2019
Existing SARs/eSARs authorized for dates of service beyond March 31, 2019, must be end-dated. Providers should review their existing EPSDT psychology, mental and behavioral health SARs/eSARs that extend beyond March 31, 2019; and submit a new SAR/eSAR with the appropriate CPT Category I national code(s) to cover any remaining service period after March 31, 2019. At the same time, providers should request existing SARs/eSARs with the HCPCS Level III local codes be end-dated effective March 31, 2019.

SARs/eSARs Submitted After April 1, 2019
Effective for dates of service on or after April 1, 2019, providers may begin requesting SARs/eSARs with CPT Category I national codes. SARs/eSARs using the HCPCS Level III local codes may be submitted only for dates of service ending on or before March 31, 2019.
SARs/eSARs with HCPCS Level III local codes received after April 1, 2019, may be denied.

Providers may need to resubmit SARs/eSARs with the appropriate CPT Category I national codes.

eSARs now accept attachments. 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 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 services 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) 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 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.