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EPSDT Home Health Code Conversion: TAR/eTAR and SAR/eSAR Policy Notice

October 25, 2018

Effective for dates of service on or after January 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health Services. These codes will be replaced by HIPAA-compliant CPT-4 Category I and HCPCS Level II national codes, utilized by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

To view the full code conversion, including relevant additional instructions, refer to the billing instructions on the HIPAA: Code Conversions webpage under the EPSDT Services: Home Health heading.

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the following instructions:

TAR/eTAR Conversion Policy
HCPCS Level III local codes will only be valid for dates of service on or before December 31, 2018. Effective for dates of service on or after January 1, 2019, new TARs/eTARs for EPSDT Home Health services must include CPT-4 Category I or HCPCS Level II national codes.

Claims for existing TARs/eTARs authorized with through dates beyond January 1, 2019, may be submitted with HCPCS Level III local codes until the end-date of that TAR/eTAR.

Guidelines for TAR/eTAR submissions are located in the Part 1 Medi-Cal provider manual.

Providers are strongly encouraged to use eTARs. Provider benefits when using the eTAR include no mail delays or postage, money savings and quicker response time. Additionally, eTARs allow providers to check the status of their TAR at any time; providers can also check the status of paper TARs using the TAR number.

For additional information, providers should look for an upcoming eTAR seminar in their area or call the Telephone Service Center at 1-800-541-5555.

SAR/eSAR Conversion Policy
HCPCS Level III local codes will only be valid for dates of service on or before December 31, 2018. Effective for dates of service on or after January 1, 2019, new SARs/eSARs for EPSDT Home Health services must include CPT-4 Category I or HCPCS Level II national codes.

Claims for existing SARs/eSARs authorized with through dates beyond January 1, 2019, may be submitted with HCPCS Level III local codes until the end-date of that SAR/eSAR.

Guidelines for SAR/eSAR submissions are located in the appropriate Part 2 provider manual under California Children’s Services (CCS) Program Service Authorization Request (SAR).

Additional information for this code conversion will publish as details are determined. Providers are encouraged to routinely check the Medi-Cal Update provider bulletins and complete the Medi-Cal Subscription Service (MCSS) Form to receive email notifications for newly published Medi-Cal Update bulletins, Newsflash articles and/or System Status Alerts.

Providers may also request additional onsite or telephone support via the Telephone Service Center (TSC) at 1 800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers calling from outside of California can contact TSC at 1-916-636-1200.