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, Programs
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
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, DHCS Notice
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, Bulletin Announcements
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, Bulletin Announcements
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, Bulletin Announcements
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.
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, DHCS Notice
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, DHCS Notice
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, Claims
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
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, Billing
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, Claims
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, Bulletin Announcements
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, Bulletin Announcements
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, DHCS Notice
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, Enhancements and Operations
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, DHCS Notice
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, DHCS Notice
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, Every Woman Counts
Updated Medical Criteria for Respiratory Durable Medical Equipment Codes
The medical criteria for DME HCPCS codes E0481, E0482 and E0483 have been updated.
Pharmacy, DHCS Notice
Every Woman Counts 2022 Income Eligibility Guidelines
EWC - Updating 2022-2023 Income Criteria, 200 Percent Federal Poverty Level.
Every Woman Counts, Bulletin Announcements
DHCS Notice, Programs
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
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, Billing
2022 HCPCS Quarter 2 Update
2022 HCPCS Quarter 2 Update
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, DHCS Notice
Multiple NCCI Modifiers Now Billable Together
Multiple NCCI Modifiers Now Billable Together.
New NDCs Available for Hemophilia Product Ixinity
New National Drug Codes (NDCs) are available when billing for Ixinity.
Billing, Pharmacy
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.
Enhancements and Operations, DHCS Notice