Title
Category
Publish Date
Medi-Cal Coverage of Community Health Worker (CHW) Services is Effective July 1, 2022
Effective July 1, 2022, Medi-Cal covers Community Health Workers (CHW) services, including violence prevention services and asthma preventive services. This NewsFlash contains information describing the CHW benefit, including billing codes and rates.
Billing
06/29/2022
Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program
DHCS announces a new Public Provider Ground Emergency Medical Transport Intergovernmental Transfer Program program to provide increased reimbursements to emergency medical transports.
DHCS Notice
06/29/2022
Coming Soon: COVID-19 Vaccine for Children 6 Months and Up
Coming Soon: FDA amended EUA to allow COVID-19 vaccines for individuals 6 months and older.
DHCS Notice
06/28/2022
New Requirements and Procedures for Non-Medical Transportation Enrollment
New requirements and procedures are established for non-medical transportation providers’ enrollment, in effect of Welfare and Institutions Code (W&I Code), Section 14132(ad)(1).
Bulletin Announcements
06/27/2022
Pfizer COVID-19 Vaccine Booster Dose Approved for Individuals 5 to 11 Years Old
Pfizer booster approved for individuals 5 to 11 years old.
COVID-19
06/23/2022
2022 COVID-19 Vaccine Administration FAQs
A FAQ has been created regarding COVID-19 vaccine administration.
COVID-19
06/22/2022
National Correct Coding Initiative Quarterly Update for July 2022
The Centers for Medicare & Medicaid Services (CMS) has incorporated the quarterly National Correct Coding Initiative (NCCI) Q1 2022 payment policy update into the Medi-Cal claims processing system.
Claims
06/16/2022
Fiscal Year 2021-2022 Two-Week Checkwrite Hold for Specific Provider Payments
Specific checkwrites scheduled in June for fiscal year 2021 – 2022 will be delayed until the start of 2022 – 2023.
Billing
06/16/2022
Updated: TAR Criteria for Inpatient Services
Update TAR criteria for inpatient services and medical criteria for acute administrative days.
Programs
06/09/2022
EWC Mammography Screening Age Restrictions Update
CPT code 77067 now a billable procedure for women under age 40 who are at high risk for breast cancer.
Every Woman Counts
06/09/2022
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
06/08/2022
HAP Client Eligibility System Updated to Capture Modality Used for Enrollment
Effective June 10, 2022, the HAP client eligibility system will be updated to capture the modality used in enrollment and recertification methods in the FPACT program. FPACT providers must denote the modality on CEC forms and in the HAP system.
Family PACT
05/31/2022
Medi-Cal Subscription Service (MCSS) is Live
Announcement that MCSS is back online, outlining what has changed and suggesting actions to take to ensure email receipt.
DHCS Notice
05/31/2022
Second Booster Dose for Select COVID-19 Boosters Now a Benefit
Updates that allow providers to bill second booster shot and clarify policy for procedure codes 0004A, 0034A, 0054A, 0064A.
COVID-19
05/23/2022
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

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