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Suspension of End of Life Option Act Services in Medi-Cal

June 14, 2018

On May 24, 2018, the Riverside County Superior Court entered a judgment in the case of Ahn, et al., v. Hestrin, et al.(Ahn), invalidating the California End of Life Option Act (the Act) on the grounds that it was enacted outside the scope of the special legislative session in which it was passed. Although the matter is currently pending before the court of appeal, effective for dates of service on or after May 24, 2018, the Department of Health Care Services (DHCS) is suspending reimbursement for the provision of aid-in-dying drugs, which were billed with the following procedure and diagnosis codes:

Procedure and Diagnosis Code Claim Type Description of Service Billed By
HCPCS code J7999 billed with ICD-10-CM Z76.89 CMS-1500 Compounded drug, not otherwise specified (NOS) Attending physicians, pharmacists
HCPCS code J8499 billed with ICD-10-CM Z76.89 CMS-1500 Prescription drug, oral, non-chemotherapeutic, not otherwise specified (NOS) Attending physicians, pharmacists

Please note that DHCS will continue to cover routine office visits involving discussions and counseling between recipients and their physicians regarding available medical options for addressing a terminal illness, including but not limited to end-of-life care planning and decisions, advance directives, hospice and palliative care. These important services will not be affected by this change in policy.

If the May 24, 2018, decision is overturned by a higher court, DHCS will immediately release a subsequent publication notifying providers of the decision and providing further directions.