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

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

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.

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

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

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.

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

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

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.

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

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.

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.

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.

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

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

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.

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

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

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.

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

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

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

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

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

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

2022 HCPCS Quarter 2 Update

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.

Multiple NCCI Modifiers Now Billable Together.

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

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.