Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | October 2016 | Bulletin 505

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1. Removal of CCS Program State Office Information for SAR Submission

State office addresses and references to state offices for the submission of Service Authorization Requests (SARs) are removed from the California Children' s Services (CCS) sections of the provider manual. Although the Department of Health Care Services (DHCS) and its affiliate state offices accept SARs via mail, providers should submit SARs to the client' s respective county office of residence.

The California Children' s Services (CCS) Program County and State Office Directory section of the Part 2 provider manual is renamed California Children' s Services (CCS) Program County Office Directory to reflect this change.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Heroine Detoxification
Hospice Care Program
Long Term Care
tar field (2)
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
cal child (1, 2, 4); cal child county (1, 10); cal child sar (1, 2, 5); tar field (2)
Local Educational Agency
Vision Care
cal child (1, 2, 4); cal child county (1, 10); cal child sar (1, 2, 5)
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2. Update to Provider Manual for IHS/MOA Visiting Nurse Services

Visiting nurse services policy for Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, clinics has been updated to reflect that the program provides the following:

This update aligns policy with Title XIX for Reimbursement for Indian Health Services and Tribal 638 Health Facilities, available on the Department of Health Care Services (DHCS) website.

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
Clinics and Hospitals
ind health (2)
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3. Termination of Several Audiology Codes

Effective for dates of service on or after November 1, 2016, the following local HCPCS audiology service codes are terminated and no longer reimbursable. These codes have been terminated due to low or no utilization.

HCPCS Code Description
X4506 Pediatric evaluation (0 – 7 years), first visit
X4508    first diagnostic follow-up
X4510    second diagnostic follow-up
X4512 Bekesy audiometry
X4514 Short increment sensitivity index (S.I.S.I)
X4516 Loudness balance test
X4518 Tone decay test
X4524 Somatosensory test 1/more nerves, physician evaluation
X4528 Hearing therapy (group), each patient
X4534 Out of office call
X4536 Weber test (tuning fork test)
X4538 Impedance audiometry (unilateral)
X4546 Electronystagmography
Z0316 Tympanometry (impedance testing), performed as part of a comprehensive audiological evaluation
Z5926 EPSDT services – central auditory processing, per test
Z5962 EPSDT services – post-cochlear implantation speech rehabilitation by audiologist, per 30 minutes

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers audio (4–6); audio cd (1, 2)
AIDS Waiver Program
Chronic Dialysis Clinics
Durable Medical Equipment
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Medical Transportation
Orthotics and Prosthetics
Pharmacy
Psychological Services
Therapies
Vision Care
medi non hcp (1)
Audiology and Hearing Aids
Rehabilitation Clinics
Therapies
audio (4–6); audio cd (1, 2); medi non hcp (1)
Clinics and Hospitals
General Medicine
medi non hcp (1); medne oto (1); rates max (3)
Obstetrics medi non hcp (1); rates max (3)
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4. 2017 ICD-10 Procedure Coding System Update

Effective for dates of service on or after October 1, 2016, the 2017 ICD-10 Procedure Coding System (PCS) codes have been updated. Specific billing policy related to this update will be published in a future Medi-Cal Update.

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5. 2016 Immunization Updates: Influenza, Meningococcal, Tdap, Hib, Rotavirus

A new DUR Educational Article titled “2016 Immunization Updates: Influenza, Meningococcal, Tdap, Hib, Rotavirus” (PDF format) is available on the DUR: Educational Articles page of the Medi-Cal website.

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6. Authorized Drug Manufacturer Labeler Codes Update

The Drugs: Contract Drugs List Part 5 – Authorized Drug Manufacturer Labeler Codes section has been updated as follows.

Additions, effective October 1, 2016
NDC Labeler Code Contracting Company's Name
39328 PATRIN PHARMA, INC.
52817 TRUPHARMA, LLC
58284 BRAEBURN PHARMACEUTICALS, INC.
59651 AUROBINDO PHARMA USA, INC.
69516 INTERCEPT PHARMACEUTICALS, INC.
69618 RELIABLE 1 LABORATORIES, LLC.
70069 SOMERSET THERAPEUTICS, LLC.
70147 GLENDALE INC.
70377 BIOCON PHARMA INC.
70515 COVIS PHARMA S.A.R.L.
70564 NAPO PHARMACEUTICALS, INC.
 
Changes, effective October 1, 2016
NDC Labeler Code Contracting Company's Name
50419 BAYER HEALTHCARE PHARMACEUTICALS

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

Provider Manual(s) Page(s) Updated
Adult Day Health Care Centers
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
Expanded Access to Primary Care Program
General Medicine
Heroin Detoxification
Home Health Agencies/Home and Community-Based Services
Hospice Care Program
Multipurpose Senior Services Program
Obstetrics
Pharmacy
Rehabilitation Clinics
drugs cdl p5 (8, 10–13, 18)
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7. 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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8. 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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9. National Correct Coding Initiative Quarterly Update for October 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 October 1, 2016.

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

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10. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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Note:

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