Contents

New Medi-Cal Benefit: Foscarnet Sodium – Effective for dates of service on or after December 1, 2008, HCPCS code J1455 (injection, foscarnet sodium, per 1000 mg) is a new Medi-Cal benefit.

Fosaprepitant is a New Medi-Cal Benefit – Effective for dates of service on or after December 1, 2008, HCPCS code C9242 (injection, fosaprepitant, 1 mg) (EMEND®) is a Medi-Cal benefit.

CPT-4 Codes 99289 and 99290 Policy and Rate Update – Effective for dates of service on or after December 1, 2008, claims billed with CPT-4 codes 99289 (critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less; first 30 – 74 minutes of hands on care during transport) and 99290 (each additional 30 minutes [list separately in addition to code for primary service]) will no longer require a Treatment Authorization Request.

Ixabepilone Policy Update – Effective for dates of service on or after December 1, 2008, reimbursement for HCPCS code C9240 (ixabepilone, 1 mg), (Ixempra®) is expanded to ICD-9-CM diagnosis codes 174 – 175.9 (malignant neoplasm of breast).

Policy Change for Menactra – Effective for dates of service on or after November 1, 2008, providers will be able to bill with CPT-4 code 90734 Menactra (meningococcal conjugate vaccine) with appropriate modifiers for recipients in the following age classifications.

Essure Policy Clarification – To clarify policy published in the June Medi-Cal Update, placement of the Essure micro-inserts does not require general anesthesia and is designed to be performed in a physician’s office.

Filgrastim and Pegfilgrastim Code Conversion and Diagnosis Restriction Changes – Effective for dates of service on or after December 1, 2008, filgrastim and pegfilgrastim will only be reimbursed when billed with the national codes and revised diagnosis restrictions.

Ganciclovir Code Conversion – To remain compliant with the Health Insurance Portability and Accountability Act (HIPPA) of 1996, effective for dates of service on or after December 1, 2008, HCPCS code X7420 (ganciclovir intravitreal implant) will no longer be reimbursable by the Medi-Cal program.

Organized Outpatient Clinics Payable Services Expanded – Effective retroactively to October 1, 2003, organized outpatient clinics exempt from licensure based on Health and Safety Code, Section 1206, may only bill for the following CPT-4 codes.

Hospital Discharge Benefits Update – Effective for dates of service on or after December 1, 2008, CPT-4 codes 99238 (hospital discharge day management: 30 minutes or less) and 99239 (hospital discharge day management: more than 30 minutes) are reimbursable for the date of hospital discharge of a newborn.

Hepatitis C Genotype Restriction Update – Effective for dates of service on or after December 1, 2008, CPT-4 code 87902 (infectious agent genotype analysis by nucleic acid [DNA or RNA]; hepatitis C virus) must be billed in conjunction with one of the following ICD-9-CM diagnosis codes.

Diagnosis Restrictions Removed for Various HIV Tests – Effective for dates of services on or after December 1, 2008, any ICD-9-CM diagnosis code may be billed with the following CPT-4 codes.

Reminder: Use the NPI for All Claims and TARs Update – Effective for dates of service on or after October 1, 2008, the Department of Health Care Services (DHCS) is only accepting the National Provider Identifier (NPI) on all Medi-Cal and Child Health and Disability Prevention (CHDP) program claims.

Antepartum OB Visit Reminder – Providers who bill for global obstetrical care must render services for at least four antepartum OB visits and must document the visits in the Reserved for Local Use field (Box 19) of the claim, or on an attachment, for reimbursement.

Immunization Recommendations in Preconception, Pregnant and Postpartum Women – Vaccines play an important role in keeping a pregnant woman and her baby healthy before, during and after pregnancy.

Changes to CDP: EWC Data Collection Application – Cancer Detection Programs: Every Woman Counts (CDP: EWC) Primary Care Providers (PCPs) are reminded that effective December 22, 2008, the following changes to the CDP: EWC Data Collection Application will affect how data is submitted online.

Authorized Drug Manufacturer Labeler Codes Update – The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Reimbursable Cochlear Implant Replacement Batteries and Accessories – Effective retroactively for dates of service on or after October 1, 2007, HCPCS codes L8621 (zinc air battery for use with cochlear implant device, replacement, each), L8622 (alkaline battery for use with cochlear implant device, any size, replacement, each) and L9900 (orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code) are reimbursable.

NDC: Reporting Workshops – Effective for dates of services on or after April 1, 2009, the National Drug Code (NDC) must be included on all physician and/or outpatient claims for services that include physician-administered or physician-dispensed drugs.

NDC Reporting Requirements – Beginning September 1, 2008, providers are encouraged to begin using the National Drug Code (NDC) for physician-administered drugs, in conjunction with the customary Healthcare Common Procedure Coding System (HCPCS) Level I, II or III code, on all Medi-Cal claims.

DUR Alert System Enhancements – Effective November 1, 2008, Drug Use Review (DUR) alerts for any newly approved drugs or updates to pre-existing drugs (i.e., newly discovered indication, adverse effect, drug-drug interaction, drug-allergy interaction, etc.) will not be generated until new system enhancements are implemented.

CCS Service Code Groupings Update – Effective July 1, 2008, HCPCS codes Q3014 and T1014 have been added to California Children’s Services (CCS) Service Code Groupings (SCGs) 01, 02, 03, 07 and 10.

CCS Physician Services Supplemental Rate Increase for Physician-Only Service Components – Effective for dates of service on or after October 27, 2008, the Department of Health Care Services (DHCS) has determined the following.

Maximum Reimbursement Rates for Pathology Codes – Effective for dates of service on or after October 27, 2008, Medi-Cal policy indicates that laboratory services are paid at the least amount of the following.

Family PACT: Provider Orientation and Update Session – Medi-Cal providers seeking enrollment in the Family PACT (Planning, Access, Care and Treatment) Program are required to attend a Provider Orientation and Update Session.

Medi-Cal List of Contract Drugs – The following provider manual sections have been updated: Drugs: Contract Drugs List Part 1 – Prescription Drugs and Drugs: Contract Drugs List Part 4 – Therapeutic Classifications Drugs.

Pages updated/corrected due to ongoing provider manual revisions:
cal child bil cms 3/4
chemo 21 thru 24
hcpcs iii 1 thru 4
oth hlth cpt 1/2
tar comp 3/4, 11/12