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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 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.

FAQs

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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 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 audiology code conversion provides the strategy for converting local audiology service procedure codes to national procedure codes. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for the claiming of audiology 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 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 speech therapy code conversion makes the necessary system modifications to ensure the speech therapy service codes are in compliance with HIPAA. The combination establishes HIPAA-compliant procedure codes for speech therapy services and deletes existing local codes.

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

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.