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NICU/PICU Services Code Conversion Billing Instructions

February 6, 2019

Effective for dates of service on or after June 1, 2019, HCPCS Level III local codes for Neonatal and Pediatric Intensive Care Unit (NICU/PICU) services will be discontinued. CPT national codes will replace local codes on NICU/PICU service claims. The NICU/PICU Services Code Conversion Crosswalk is available for reference.

New Service Authorization Requests (SARs)/electronic SARs (eSARs) for NICU/PICU services must include CPT national codes effective for dates of service on or after June 1, 2019. SARs/eSARs using converting HCPCS Level III local codes will only be valid for dates of service ending on or before May 31, 2019.

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

If the submitted SAR/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 will be released in a future Medi-Cal Update.