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All Communities - Latest News

Medi-Cal News Articles

Title

Category

Publish Date

Antiretroviral Ibalizumab-uiyk Injection Available for Managed Care Plans

HCPCS code J1746 is a capitated service for CalOptima and Health Plan of San Mateo but non-capitated for all other Manage Cared Plans.

DHCS Notice

05/20/2022

Available Sessions for the June Virtual Claims Assistance Room (CAR) Event

A reminder that one-on-one billing assistance appointments are available to join the Virtual Claims Assistance Room (CAR) event in June.

Outreach and Education

05/20/2022

LTC Providers Will Transition to the UB-04 Claim Form

Once DHCS has decided that LTC providers are ready, the local Payment Request for Long Term Care (LTC) 25-1 form will transition to the UB-04 claim form.

Claims

05/16/2022

Reporting Procedure for Intermittent Clinics and Mobile Health Units

Update to reporting procedure for new or converted intermittent clinics and mobile health units pursuant to W&I Code Section 14043.15(e).

Provider Enrollment

05/12/2022

2022 HPE Income Eligibility Guidelines

The Hospital Presumptive Eligibility program income eligibility guidelines have been updated for 2022. Providers must use the new guidelines when determining program eligibility.

Programs

05/09/2022

CHDP Gateway Program 2022 Income Eligibility Guidelines

Effective January 1, 2022, through December 31, 2022, providers are to use the 2022 Federal Poverty Level Guidelines when determining recipient eligibility for pre-enrollment in Medi-Cal through the CHDP Gateway program.

DHCS Notice

05/09/2022

2022 Income Eligibility Guidelines for PE4PW

Article notifying providers of updates to presum and presum proc MRPs updating the Federal Poverty Level guidelines for PE4PW for 2022.

Billing

05/09/2022

Hepatitis B Vaccine Code 90759 is Now a Medi-Cal Benefit

Hepatits B vaccine code 90759 is a Medi-Cal benefit for beneficiaries 18 years of age and older.

Billing

05/06/2022

Postpartum Care Expansion for Medi-Cal and MCAP Beneficiaries

An individual eligible for pregnancy and postpartum care services under MCAP is entitled to an additional ten months postpartum coverage at the end of their 60-day postpartum period for a total 12 months of postpartum coverage.

COVID-19

05/06/2022

Rebilling Period Provided for Telehealth Claims Denied Using TOB 02

DHCS has provided outpatient providers a period to rebill for telehealth claims that were denied using TOB 02.

Billing

05/04/2022

Medi-Cal Provider Website: Improvements to Transaction Services

The Medi-Cal Provider website will be updated to improve user experience. This update includes multiple subscriber eligibility application, removal of unused swipe card, eligibility response, and several minor bug fixes to various applications.

Enhancements and Operations

04/28/2022

Notification: DRG Payment System Update to Mapper and HAC v39-1

ICD-10-CM codes have been added to the system for the DRG program to align with updates made by CMS on April 1, 2022.

Programs

04/26/2022

Claims Processing Error Affecting Select Home Dialysis Codes Resolved

System updates have occurred to correct the previously announced claims processing issue that was erroneously denying claims for HCPCS home dialysis codes S9335 and S9339.

Billing

04/25/2022

July 2022 Medi-Cal Provider Coffee Break Event

Medi-Cal will hold virtual “Coffee Break” sessions in July for providers on category specific topics.

Outreach and Education

04/25/2022

2022 Income Eligibility Guidelines for Family PACT Program

The 2022 Federal Poverty Guidelines for the Family PACT Program are updated, effective April 1, 2022.

Family PACT

04/22/2022

Sotrovimab No Longer Authorized to Treat COVID-19

Due to increases in the proportion of COVID-19 cases caused by the Omicron BA.2 Sub-Variant, Sotrovimab is no longer authorized to treat COVID-19 in any U.S region.

COVID-19

04/22/2022

Updates to the Medi-Cal Learning Portal

The Medi-Cal Learning Portal is updated to validate user inputs for National Provider Identifier fields.

Outreach and Education

04/21/2022

FQHC, RHC and Tribal FQHC Providers May Now Submit Claims for COVID-19 Vaccine Administration

FQHC, RHC and Tribal FQHC providers may receive reimbursement for administration of the COVID-19 vaccines during vaccine-only encounters.

COVID-19

04/15/2022

Coming Soon: Second Booster Dose for Select COVID-19 Vaccines

The U.S. FDA amended the EUA for select COVID-19 vaccines to allow for a second booster dose to eligible populations to be administered at least four months after initial booster dose.

COVID-19

04/14/2022

EWC Program Recipient Application Available in Three New Languages

The Every Woman Counts Recipient Application (DHCS 8699) is now available in Hindi, Punjabi and Ukrainian.

Forms

04/08/2022

Updated Medical Criteria for Respiratory Durable Medical Equipment Codes

The medical criteria for DME HCPCS codes E0481, E0482 and E0483 have been updated.

Pharmacy

04/08/2022

Every Woman Counts 2022 Income Eligibility Guidelines

EWC - Updating 2022-2023 Income Criteria, 200 Percent Federal Poverty Level.

Every Woman Counts

04/08/2022

Child Health and Disability Prevention Program and Expanding Children's Presumptive Eligibility

DHCS is proposing to discontinue CHDP by July 1, 2023.

DHCS Notice

04/06/2022

Los Angeles County Fee-For-Service Pharmacy Providers Risk Level Updated to Limited

The fraud, waste and abuse designation for fee-for-service pharmacy providers has updated to “limited” effective May 5, 2022.

DHCS Notice

04/05/2022

Reminder: Every Woman Counts Program Approved CPT Codes and Appropriate ICD-10-CM Codes Updated

Reminder for recently updated and approved CPT Codes and ICD-10-CM Codes list for referral providers of the EWC program.

Every Woman Counts

04/04/2022

2022 HCPCS Quarter 2 Update

HCPCS

04/01/2022

Temporary Extension of Claims Submission Deadline for LEA Providers

LEA Providers with outstanding claims with dates of service on or after September 1, 2020, through May 31, 2021 will have until June 30, 2022, to submit claims without any timeliness-related reimbursement cutbacks.

Claims

04/01/2022

Multiple NCCI Modifiers Now Billable Together

Multiple NCCI Modifiers Now Billable Together.

Billing

03/29/2022

New NDCs Available for Hemophilia Product Ixinity

New National Drug Codes (NDCs) are available when billing for Ixinity.

Billing

03/29/2022

Older Adult Expansion into Full Scope Medi-Cal

DHCS introduces the Older Adult Expansion, which will provide full-scope Medi-Cal to individuals 50 years of age and older, beginning May 1, 2022.