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EPSDT Psychology, Mental & Behavioral Health Code Conversion: Technical Support

December 5, 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.

Providers and submitters who bill for EPSDT psychology, mental and behavioral health services using the ANSI 837P and 837I transactions for electronic billing are encouraged to visit the Testing and Activation Procedures section of the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual.

Submitters may test status to ensure accurate file format, completeness and validity for HIPAA-compliant claims transactions by logging into the Medi-Cal test site using their submitter ID and password. Instructions for CMC testing is located in the Testing and Activation Procedures section of theCMC Billing and Technical Manual.

CMC evaluates the test file and determines if the following requirements have been met for all format types:

  • Telecommunications equipment is technically compatible with the DHCS Fiscal Intermediary (FI) system
  • The claim data can be read by the claims processing system
  • Records and mandatory fields required for CMC are present and contain valid information (for example, provider number[s], submitter number, control records, claim records)
Note:

A new test must be submitted when software is upgraded or the submission method changes.

For electronic claim submission questions, contact the Telephone Service Center (TSC) at 1 800-541-5555, select option “4” for the Technical Help Desk and option “2” for CMC.

For additional information, providers may:

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.