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

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

March 1, 2019

Effective for dates of service on or after June 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 national codes 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 EPSDT Psychology, Mental and Behavioral Health Service Code Conversion Billing Instructions 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 June 1, 2019, new TARs/eTARs for EPSDT psychology, mental and behavioral health services must include CPT national codes. TARs/eTARs using the HCPCS Level III local codes will only be valid for dates of service on or before May 31, 2019.

TARs/eTARs Previously Authorized with Through Dates Beyond May 31, 2019
TARs/eTARs with service “from” and “through” dates on or before May 31, 2019, should be submitted using HCPCS Level III local codes. TARs/eTARs authorized with “through” dates beyond May 31, 2019, must be end dated, and a new TAR/eTAR should be submitted with the appropriate CPT national code(s) to cover any remaining service period on or after June 1, 2019.

TARs/eTARs Submitted On or After June 1, 2019
All TARs/eTARs submitted on or after June 1, 2019, that require authorization beyond this date must include only CPT 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 requests 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 Part 1 provider manual.

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

SARs/eSARs Previously Authorized with Through Dates Beyond May 31, 2019
SARs/eSARs with service “from” and “through” dates on or before May 31, 2019, should be submitted using HCPCS Level III local codes. SARs/eSARs authorized with “through” dates beyond May 31, 2019, must be end dated, and a new SAR/eSAR should be submitted with the appropriate CPT national code(s) to cover any remaining service period on or after June 1, 2019.

SARs/eSARs Submitted On or After June, 2019
All SARs/eSARs submitted on or after June 1, 2019, that require authorization beyond this date must include only CPT national codes.

Electronic SARs 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 helpful 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) Subscriber Form to receive timely notifications related to EPSDT psychology, mental and behavioral health services.

Providers may also request additional onsite or telephone support via 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.