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NICU/PICU Services Code Conversion: SAR/eSAR Policy Notice

April 3, 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 Neonatal and Pediatric Intensive Care Unit (NICU/PICU) services. These codes will be replaced by HIPAA-compliant CPT national codes, used by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

To view the full NICU/PICU Services Code Conversion, including relevant additional instructions, refer to the NICU/PICU Services Code Conversion Crosswalk located under the NICU/PICU Services heading of the HIPAA: Code Conversions web page.

Providers should prepare and submit Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the following instructions:

SAR/eSAR Conversion Policy
Effective for dates of service on or after June 1, 2019, new SARs/eSARs for NICU/PICU 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 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 after June 1, 2019.

SARs/eSARs Submitted After June 1, 2019
Effective for dates of service on or after June 1, 2019, SAR/eSARs with service “from dates” on or after June 1, 2019, should be submitted with CPT national codes. SARs/eSARs using the HCPCS Level III local codes may be submitted only for dates of service ending on or before May 31, 2019.

SARs/eSARs with HCPCS Level III local codes received after June 1, 2019, will no longer be reimbursed. Providers may need to resubmit SARs/eSARs with the appropriate CPT national code(s).

eSARs now accept attachments. California Children's Services and Genetically Handicapped Persons Program providers interested in learning more about eSAR submissions should contact the Centers for Medicare & Medicaid Services (CMS) Net Help Desk at cmshelp@dhcs.ca.gov or 1-866-685-8449 for guidance and additional information.