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NICU/PICU Services Code Conversion: Technical Publications and Support

February 25, 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.

Providers who bill for NICU/PICU 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 the status to ensure an 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 are located in the Testing and Activation Procedures section of the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual.

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

  • Telecommunications equipment is technically compatible with the California Medicaid Management Information System (MMIS) 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 may complete the Medi-Cal Subscription Service (MCSS) Subscriber Form to receive timely notifications related to NICU/PICU services.