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
Medi-Cal Rx Billing Policy for Physician Administered Drugs
PADs should be billed to Medi-Cal. PADs should not be billed to Medi-Cal Rx, except in a few exceptions based upon medical necessity.
Claims, DHCS Notice
Monthly Block-Billing and By Report Billing Required for Home Dialysis Codes
Monthly block-billing and by-report billing is required for HCPCS codes S9335 and S9339. A claims processing issue related to this policy has been identified. Thus, an EPC will be implemented to reprocess erroneously denied claims.
Billing, Claims
Vaccine Counseling Services are Reimbursable using E and M Office or Other Outpatient Visit CPT codes
California recognizes the importance of vaccinating all Medi-Cal beneficiaries against infectious diseases, including COVID-19, and recognizes that counseling services may be required to assist in that effort.
Billing, DHCS Notice
Every Woman Counts Removes Forms in Response to Recent Benefit Changes
Providers are encouraged to discard select EWC forms that are being temporarily removed from the Medi-Cal Provider website until they are updated to reflect current policy.
Every Woman Counts, DHCS Notice
Provider Billing Resources Reminder
Providers are reminded of assistance available via the Telephone Service Center, Provider Field Representatives and the Small Provider Billing Assistance and Training Program.
Billing, Telephone Service Center
National Correct Coding Initiative Quarterly Update for March 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.
Aid Code Definitions Expanded for ARPA Postpartum Care Extension
Postpartum aid codes descriptions have been updated for aid codes M0, M8, M9, and 76.
Programs, DHCS Notice
Frequency Limits Updated for COVID-19 Related Laboratory Codes
Frequency limits are updated for select COVID-19 related laboratory codes
COVID-19, Billing
April 2022 Medi-Cal Provider Coffee Break Event
DHCS and Outreach and Education (O&E) are hosting virtual coffee break events to discuss billing topics during the month of April.
Outreach and Education