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Medi-Cal Update

Acupuncture | March 2021 | Bulletin 546

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1. Updated CCS COVID-19 Guidance, CCS FAQs and COVID Vaccine Flexibilities

The Department of Health Care Services (DHCS) recently developed and posted the following documents to the COVID-19 Information for Providers & Partners web page to provide Coronavirus disease (COVID-19) related guidance for the California Children’s Services (CCS) Program:

  1. Updated CCS COVID-19 Guidance

  2. CCS FAQs for COVID-19 Flexibilities

  3. Flexibilities for County Staff during COVID Vaccine Administration

These documents are also available on the CCS Letters web page.

2. Rates for Certain COVID-19 Diagnostic Testing HCPCS Codes Updated

Effective for dates of service on or after January 1, 2021, the base payment amount for HCPCS Codes U0003 (Infectious agent detection by nucleic acid [DNA or RNA]; Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)], amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R), and U0004 (2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV [COVID-19], any technique, multiple types or subtypes [includes all targets], non-CDC, making use of high throughput technologies as described by CMS-2020-01-R), has been adjusted from $100 to $75.

HCPCS Code Description Current Rate New Rate
U0003 SARS Cov-2 COVID-19 Amp prob high throughput $100.00 $75.00
U0004 COVID-19 lab test non-CDC high throughput $100.00 $75.00

Additionally, the codes listed above will be exempt from the 10 percent payment reductions in Welfare and Institutions Code (W&I Code) section 14105.192, as described at Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan.

An Erroneous Payment Correction (EPC) will be issued for affected claims for codes U0003 and U0004 retroactive to dates of service on or after January 1, 2021.

3. New ICD-10-CM and ICD-10 PCS Diagnosis Codes Related to COVID-19

Effective for dates of service on or after January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has added new ICD-10-CM codes and ICD-10 PCS codes for diagnoses related to coronavirus disease 2019 (COVID-19). Information and downloads for these codes can be found on the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update and Family PACT Update.

4. National Correct Coding Initiative Quarterly Update for April 2021

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 effective for dates of service on or after April 1, 2021.

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

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