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Medi-Cal News Articles

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

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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Bulletin Archives

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Part 1 - Medi-Cal Program & Eligibility Bulletin

Allied Health Bulletins

Acupuncture (ACU)

Audiology and Hearing Aids (AUD)

Chiropractic (CHR)

Durable Medical Equipment and Medical Supplies (DME)

Medical Transportation (MTR)