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Claims Processing Issue Affecting AIDS Medi-Cal Waiver Program Providers

May 17, 2018

The Department of Health Care Services (DHCS) has identified a claims processing issue causing AIDS Medi-Cal Waiver Program (MCWP) providers to be paid incorrectly. The issue affects claims received on or after April 23, 2018, for dates of service on or after July 1, 2017. The affected codes are as follows:

CPT-4 or
HCPCS Code
Description
90837 Psychotherapy, 60 minutes with patient
90846 Family psychotherapy (without the patient present), 50 minutes
90847 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
G0156 Services of home health/hospice aide in home health or hospice settings, each 15 minutes
G0299 Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting, each 15 minutes
G0300 Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting, each 15 minutes
S5130 Homemaker service, NOS; per 15 minutes
S9470 Nutritional counseling, dietitian visit
T2003 Nonemergency transportation; encounter/trip
T2022 Case management, per month
T2025 Waiver services; not otherwise specified (nos)

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. No action is required of providers.