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Revisions to 2016 CPT-4/HCPCS Annual Update

October 5, 2016

A previously published Medi-Cal Update added, changed and deleted CPT-4 and HCPCS codes for the 2016 annual update, effective October 1, 2016. The following policy has been revised:

Audiology
CPT-4 codes 92537 (caloric vestibular test with recording, bilateral; bithermal) and 92538 (…monothermal) may be split-billed with modifier 26 or TC.

Blood Factor
HCPCS codes J7188 (injection, factor viii [antihemophilic factor, recombinant] [obizur], per i.u.) and J7205 (injection, factor viii fc fusion [recombinant], per iu) must be billed “By Report.”

DME
The purchase price for HCPCS code E1012 (wheelchair accessory, addition to power seating system, center mount power elevating leg rest/platform, complete system, any type, each) is $75.99. There is no rental price.

Laboratory
The frequency limit for CPT-4 code 80081 (obstetric panel [includes HIV testing]) is once in nine months. Providers may only be reimbursed for either code 80055 (obstetric panel) or 80081 in a nine month period.

CPT-4 codes 83992 (phencyclidine) and 80300 – 80377 (drug assay) are no longer Medi-Cal benefits.

Medicine
HCPCS code J7302 (levonorgestrel-releasing intrauterine contraceptive system, 52 mg) has been replaced by codes J7297 (levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 3 year duration) and J7928 (levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 5 year duration).

J7328 (hyaluronan or derivative, Gel-Syn®, for intra-articular injection, 0.1 mg) must be billed “By Report.”