Medi-Cal Update

Acupuncture | August 2016 | Bulletin 491

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1. Acupuncture Services Are Restored

Effective for dates of service on or after July 1, 2016, in compliance with Senate Bill 833, acupuncture services have been restored. They are reimbursed as follows:

CPT-4
Code
Description Maximum Allowance
97810 Acupuncture, one or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient $5.79
97811
without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s)
$5.79
97813
with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
$5.79
97814
with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s)
$5.79

This information is reflected in the following provider manual(s):

Provider Manual(s) Page(s) Updated
Acupuncture
Rehabilitation Clinics
acu (1–3); acu cd (1); opt ben exc (1, 2, 4, 6, 18)
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2. 2016 CPT-4/HCPCS Annual Update: Policy Updates

The 2016 updates to the Current Procedural Terminology – 4th Edition (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) National Level II codes are available in the 2016 CPT-4/HCPCS Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after October 1, 2016. Please refer to the 2016 CPT-4 and HCPCS Level II code books for complete descriptions of these codes. Manual replacement pages reflecting these changes will be released in a future Medi-Cal Update.

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3. Reminder Regarding Guidelines for TAR and eTAR Submission

Effective for dates of service on or after July 1, 2016, Senate Bill 1457 requires paper Treatment Authorization Request (TAR) submission to remain an option for small providers and low-volume TAR submitters, and when electronic TAR (eTAR) submission is not possible due to technical limitations or practicality.

Providers interested in switching from paper TAR submission to eTAR submission should contact the Medi-Cal Provider Outreach & Education team for more information. Contact information is located on the Outreach & Education Web page of the Medi-Cal website.

As published in previous Medi-Cal Updates, unless otherwise directed by Medi-Cal, all paper TARs should be sent to the following location:

TAR Processing Center
820 Stillwater Road
West Sacramento, CA 95605-1630

If a provider submits a TAR to a field office, the TAR will be returned to the provider with instructions to send the TAR to the TAR Processing Center.

For TAR status or issues, providers may call the Telephone Service Center (TSC) at 1-800-541-5555. Providers outside of California may call (916) 636-1960.

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4. Provider Manual Survey Now Available

Department of Health Care Services (DHCS) offers the Provider Manual on the Medi-Cal website in Microsoft Word format and as a ZIP (compressed file). The website also contains links to free software to view these file formats.

DHCS is exploring modernizing the Medi-Cal, Child Health and Disability Prevention (CHDP) and Family Planning, Access, Care and Treatment (Family PACT) provider manuals to reflect the shift to mobile computing.

This Provider Manual Survey will collect provider feedback on this modernization effort. Responses will help DHCS assess provider concerns about moving toward a more mobile-friendly platform. While participation is not required, DHCS encourages all providers to take the survey. All answered surveys will be kept confidential and anonymous.

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5. Provider Manual Indexes Survey

The Medi-Cal and specialty program provider manuals include online indexes that assist providers in finding information in the provider manuals. The Medi-Cal website also includes an online search tool that allows providers to quickly search key words and locate appropriate policy information in the provider manuals.

The Department of Health Care Services (DHCS) is exploring an idea to retire the index sections from the Medi-Cal, Child Health and Disability Prevention (CHDP) and Family Planning, Access, Care and Treatment (Family PACT) provider manuals.

DHCS developed the Manual Indexes Survey to collect provider feedback. Responses will help DHCS assess any provider issues or concerns about retiring the indexes. While participation is not required, DHCS encourages all providers to take the survey. All answered surveys will be kept confidential and anonymous.

Providers should note an Acronyms and Abbreviations Glossary section will remain in the provider manuals to assist providers with acronyms, and the Medi-Cal website’s search function will still be available for provider use.

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6. National Correct Coding Initiative Quarterly Update for July 2016

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are valid for dates of service on or after July 1, 2016.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

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7. September 2016 Medi-Cal Provider Seminar

The next Medi-Cal Provider Seminar is scheduled for September 13 – 14, 2016, at the Long Beach Marriott in Long Beach, California. Providers can access a class schedule for the seminar by visiting the Provider Training Web page of the Medi-Cal Learning Portal (MLP) and clicking the seminar date(s) they would like to attend. Providers may RSVP by logging in to the MLP.

Throughout the year, the Department of Health Care Services (DHCS) and the Fiscal Intermediary for Medi-Cal, Xerox State Healthcare, LLC (Xerox), conduct Medi-Cal training seminars. These seminars, which target both novice and experienced providers and billing staff, cover the following topics:

Providers must register by August 30, 2016, to receive a hard copy of the Medi-Cal provider training workbooks on the date(s) of training. After August 30, 2016, the workbooks will be available only by download on the Medi-Cal Provider Training Workbooks Web page of the Medi-Cal website.

Providers that require more in-depth claim and billing information have the option to receive one-on-one claims assistance, which is available at all seminars, in the Claims Assistance Room.

Providers may also schedule a custom billing workshop. On the Lookup Regional Representative page, enter the ZIP code for the area you wish to search and click the “Enter ZIP Code” button. The name of the designated field representative for your area will appear on the map. To contact a regional representative, providers must first contact the Telephone Service Center (TSC) at 1-800-541-5555 and request to be contacted by a representative.

Providers are encouraged to bookmark the Provider Training Web page and refer to it often for current seminar information.

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