Federally Qualified Health Center (FQHC) Alternative Payment Methodology (APM) Webinar
On September 30, DHCS will host a webinar from 2:30 to 4:30 pm to introduce stakeholders of the new FQHC APM.
DHCS Notice
Billing Issue Resolved: Evaluation and Management Code 99202 with TD Modifier
News article announcing the resolution of a previously noted billing issue with E&M Code 99202 with TD Modifier.
Billing, Bulletin Announcements
Billing Update for Bebtelovimab Use for COVID-19 Treatment
Effective for DOS on or after 8/15/2022, commercial distribution of bebtelovimab began, which DHCS will reimburse when billed with HCPCS code Q0222.
Addition of Novavax COVID-19 Vaccine
Addition of Novavax COVID-19 vaccine administration for ages 18 years and older and additional administration codes for Moderna vaccine.
COVID-19, DHCS Notice
New Laboratory Test for Orthopoxvirus is a Medi-Cal Benefit
Orthopox virus test, CPT® code 87593, is a new Medi-Cal benefit.
Monkeypox, DHCS Notice
National Correct Coding Initiative Quarterly Update for October 2022
The Centers for Medicare & Medicaid Services (CMS) has incorporated the quarterly National Correct Coding Initiative (NCCI) Q3 2022 payment policy update into the Medi-Cal claims processing system.
UPDATE: Planned System Upgrade for September 17, 2022
There is a planned East End outage for September 17, 2022 for HVAC replacement activities.
DHCS Notice
Coming Soon: Bivalent Booster Dose for Select COVID-19 Vaccines
The U.S. FDA amended the EUA for a Bivalent booster formulation for select COVID-19 vaccines.
DHCS Notice, COVID-19
LTC Code and Claim Form Conversion: Crosswalks and FAQ are Available
LTC providers are transitioning away from the use of LTC service codes and the local Payment Request for Long Term Care 25-1 form.
October 2022 Medi-Cal Provider Coffee Break Event
Medi-Cal will hold a virtual “Coffee Break” event in October for providers to ask questions and learn about various Medi-Cal related topics.
Outreach and Education, Bulletin Announcements
CCS Service Code Groupings Policy Update
The following codes have been added to SCG 04 and SCG 05: 92650, 92651, 92652, 92653, 92517, 92518, 92519 for the California Children’s Services program.
Programs, Billing
ICD-10-CM Code Related to COVID-19 End-Dated
One ICD-10-CM code related to COVID-19 has been end-dated.
DHCS Notice, COVID-19
FQHC, RHC and Tribal Clinic Providers: Abortion Services
Effective October 1, 2022, DHCS Medi-Cal Program will reimburse FQHC, RHC, IHS-MOA and Tribal FQHC provides at a fee-for-service rate for abortion services.
Billing, DHCS Notice
Family PACT Provider Enrollment and Responsibilities Policies Updated
DHCS has updated the requirements for provider enrollment and responsibilities into the Family PACT program effective August 15, 2022.
Family PACT, Provider Enrollment
Available Sessions for the September Virtual Claims Assistance Room Event
Appointments are still available during the month of September for free one-on-one billing assistance at our Virtual Claims Assistance Room (CAR) Event.
Outreach and Education
Pregnancy Coverage During the COVID-19 Public Health Emergency
Providers are advised to continue to provide beneficiaries in pregnancy related aid codes with any medically necessary service through the duration of the PHE.
DHCS Notice, COVID-19
Supplemental Payment Program for Non-Hospital 340B Clinics, General Updates
DHCS developed eligibility criteria for the Supplemental Payment Program for non-hospital based 340B clinics. Complete and submit the application to participate.
Programs, DHCS Notice
Monkeypox (Mpox) Vaccine Administration - General Updates
DHCS continues to monitor the Monkeypox situation and will update and inform all Medi-Cal providers on any reimbursement policy for vaccine administration, testing and treatment as guidance becomes available.
DHCS Notice, Monkeypox
Update: New Provider Portal Online Gateway
Medi-Cal announces new Provider Portal with electronic services made available to fee-for-service billing providers.
DHCS Notice, Provider Enrollment
Reminder: COVID-19 Oral Antivirals for Uninsured Group
DHCS reminds providers the COVID-19 related therapeutics are covered by Medi-Cal for the uninsured.
COVID-19, DHCS Notice
Correction to National Correct Coding Initiative Quarterly Update for July 2022
Correction to NCCI Medically Unlikely Edit value for HCPCS code J7295.
Billing, DHCS Notice
New Provider Portal Online Gateway
Medi-Cal announces new Provider Portal with electronic services made available to Fee-For-Service billing providers.
DHCS Notice, Provider Enrollment
Allowable Modifiers Added for CHW and APS Services
New allowable modifiers can be added when billing for Community Health Worker (CHW) services and Asthma Preventative services (APS).
Billing, Claims
New ICD-10-CM and ICD-10-PCS Codes Related to COVID-19
Update to ICD-10-CM and PCS code mapping for COVID-19.
COVID-19, DHCS Notice
Billing Issue: Evaluation and Management Code 99202 with TD Modifier
The Department of Health Care Services is aware of the billing issue with Evaluation and Management code 99202 with TD modifier.
DHCS Notice, Billing
PAVE Portal for Family PACT Providers
Family PACT providers may now use the Provider Application and Validation for Enrollment (PAVE) portal.
Family PACT, Provider Enrollment
Beneficiary Eligibility Verification Reminder
Reminder to providers to verify beneficiary eligibility and the Medi-Cal billing policy before providing services.
DHCS Notice, Billing
Coming Soon: Monkeypox Vaccines as Medi-Cal Benefits
Two Monkeypox Vaccines will soon be available as Medi-Cal Benefits.
DHCS Notice
New Provider Financial Data Request Form Available
To aid providers with requesting financial data from the Financial Cash Control Unit (FCCU), a specific request form is now available.
Forms, DHCS Notice
Coming Soon: Novavax COVID-19 Vaccine Authorization
The FDA has amended the EUAs for the addition of the Novavax COVID-19 vaccine for individuals 18 years of age and older.
COVID-19, DHCS Notice