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HIPAA: Code Conversions

The Health Insurance Portability and Accountability Act (HIPAA) mandates the standardization of internal (administrative) code sets and the use of standard service/procedure code sets for transactions. The Medi-Cal program is using a phased approach to convert its interim (local) codes to national values.

The links below provide additional information about Medi-Cal code conversions. Providers and submitters are encouraged to check this page periodically for new information.

General FAQs

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The audiology/speech therapy code conversion provides the strategy for converting HCPCS Level III procedure codes to valid HCPCS Level II national procedure codes for audiology, Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and speech therapy services. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for the claiming of audiology and speech therapy services.

Additional information for this project will publish as details are determined.

Child Health and Disability Prevention (CHDP) program code conversion transitions providers billing CHDP Medi-Cal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) health assessments, immunizations, and ancillary services using local codes to billing these services with HIPAA-compliant code sets. This transition will occur over two phases in 2017. Transitioning from billing services with local codes on the Confidential Screening/Billing Report (PM 160) to billing national codes on the CMS-1500 or UB-04 claims, or electronic equivalents, will be based on a date-of-service cutover under each phase.

Additional information for this project will publish as details are determined.

The dialysis code conversion establishes HIPAA-compliant procedure codes for dialysis services by replacing the non-HIPAA-compliant Z-codes. The alternative solution includes utilization of revenue codes, CPT codes, HCPCS Level II codes and modifiers.

Additional information for this project will publish as details are determined.

The ECMO/ECLS Services code conversion provides the strategy for converting the local procedure code to national procedure codes. HIPAA-compliant procedure codes are identified to reimburse providers for the claiming of ECMO/ECLS services.

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Rural Health Clinics (RHCs) extend Medicare and Medi-Cal benefits to cover health care services provided by clinics operating in rural areas. Specifically trained primary care practitioners administer the health care services needed by the community when access to traditional physician care is difficult.

Federally Qualified Health Centers (FQHCs) were added as a Medi-Cal provider type in response to the Federal Omnibus Budget Reconciliation Act (OBRA) of 1989. The Department of Health Care Services’ Audits and Investigations Division provides oversight responsibility for the RHC and FQHC programs.

Indian Health Services/Memorandum of Agreement (IHS/MOA) is the health care system for federally-recognized American Indian and Alaska Natives in the United States. The IHS is not a health insurance provider, and the IHS provides healthcare only to eligible Alaska Native and American Indians at its federal hospitals and clinics.

The FQHC, RHC, and IHS/MOA code conversion establishes HIPAA-compliant procedure codes for FQHC, RHC and IHS services. The solution replaces the non-HIPAA-compliant local codes, commonly referred to as “Z-codes,” currently used. The alternative solution includes utilization of Revenue Codes, CPT codes, HCPCS Level II codes and modifiers.

Additional information for this project will publish as details are determined.

The home health code conversion provides the conversion strategy for local home health care service procedure codes to national procedure codes. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for the claiming of home health services.

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The hospice care code conversion provides the strategy for converting local hospice service procedure codes to national procedure codes. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for the claiming of hospice services.

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The current set of two-digit local codes used for the claiming of LTC services is replaced with revenue and diagnosis codes. Providers must bill on a UB-04 claim.

Additional information for this project will publish as details are determined.

The maternal Comprehensive Perinatal Services Program (CPSP) code conversion provides the strategy for converting the CPSP local codes to national procedure codes. HIPAA-compliant HCPCS Level II codes have been identified to reimburse CPSP providers.

Additional information for this project will publish as details are determined.

The medical services other code conversion makes the necessary system modifications to ensure the medical services codes are in compliance with HIPAA. The combination establishes HIPAA-compliant procedure codes for medical services and deletes existing local codes.

Additional information for this project will publish as details are determined.

The medical transportation code conversion terminates the following items used for billing medical transportation services: local codes, the current set of 46 non-HIPAA compliant local codes, and one local modifier. The conversion also establishes HIPAA-compliant HCPCS codes and HCPCS modifiers, including HCPCS origin/destination modifiers developed by the Centers for Medicare and Medicaid Services (CMS) exclusively for medical transportation services.

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A code conversion for the following services updates codes and discontinues local procedure codes:

  • Psoriasis day care
  • Sign language interpreter
  • Lead screen/council and blood-draw services
  • Services provided in specific Special Care Centers (SCC) to California Children Service’s (CCS) recipients

Additional information for this project will publish as details are determined.

The Multipurpose Senior Services Program (MSSP) code conversion brings MSSP services into federal compliance by matching nonstandard HCPCS Level III codes to a pre-existing HIPAA internal or external code set. The National Uniform Billing Committee (NUBC) maintains and publishes the external code-set list of revenue codes. Medi-Cal intends to utilize the NUBC list of revenue codes as they pertain to MSSP services, along with CPT and HCPCS Level II codes.

Additional information for this project will publish as details are determined.

The neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) code conversion establishes HIPAA-compliant procedure codes by terminating the use of HCPCS Level III service procedure codes. The update references valid HCPCS Level II national procedure codes for bill-intensive, care-unit services for both neonatal and pediatric services.

Additional information for this project will publish as details are determined.

The organ procurement code conversion provides the conversion strategy for local organ procurement procedure codes to national procedure codes. HIPAA-compliant HCPCS procedure codes are identified to reimburse non-contract hospitals for the claiming of organ procurement services. The HIPAA-compliant procedure codes used to reimburse providers for the acquisition and procurement of organs from living or cadaver donors in preparation for transplant procedures, and to delete existing local procedure codes.

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The outpatient services code conversion establishes HIPAA-compliant procedure codes used to reimburse providers for hospital outpatient services such as the use of hospital facilities, hyperbaric oxygen therapy and hotel services. This code conversion also deletes existing local procedure codes and replaces non-HIPAA-compliant Z-codes. The alternative solution includes utilization of revenue codes, CPT and HCPCS Level II codes and modifiers.

Additional information for this project will publish as details are determined.