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Medi-Cal Update

Community - Based Adult Services (formerly Adult Day Health Care Centers) | November 2020 | Bulletin 554

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1. Reimbursement Rates are Updated for COVID-19 Testing

Effective for dates of service on or after August 10, 2020, CPT® codes 86408 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; screen) and 86409 (neutralizing antibody, severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)]; titer) have updated reimbursement rates.

Additionally, the Department of Health Care Services (DHCS) is establishing the reimbursement rates at 100 percent of the Medicare rate for 86408 and 86409. These codes are exempt from the ten percent payment reductions in Welfare and Institutions Code (W&I Code) Section 14105.192.

Upon expiration of the Public Health Emergency or National Emergency, these rates will be amended to correspond with the clinical laboratory services methodology in W&I Code Section 14105.22, including the application of the Assembly Bill 97 (AB 97) payment reduction.

Updated rates are as follows:

Codes Description Medicare Rate
86408 Neutralizing antibody, (SARSCoV-2), screen $42.13
86409 Neutralizing antibody, (SARSCoV-2), titer $79.61

An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

2. New Provider Web Page and Checklist on the Medi-Cal Provider Website

The Department of Health Care Services (DHCS) encourages new providers to visit its New Provider web page. It was launched simultaneously with its new Medi-Cal Provider website earlier this year.

Medi-Cal’s New Provider web page offers an organized and central location for key information, guided steps, helpful documents and charts, as well as direct links to areas of the Medi-Cal Provider website that a new provider is encouraged to visit to help setup and have a successful future as a provider within the Medi-Cal program.

The New Provider web page is located in the Providers tab on the new Medi-Cal Provider website. The web page includes important information on the following subject matters:

  • Billing Basics

  • Checkwrite and Remittance Advice Details (RADs)

  • Claim Forms and Claim Timeliness (online and paper-based)

  • Eligibility and Share of Cost (SOC)

  • Links to Medi-Cal Learning Portal (MLP), Medi-Cal Subscription Service (MCSS) and Provider Enrollment

  • Provider Publications (including Frequently Asked Questions)

  • Provider Training (including Provider Training Seminar information)

  • Medi-Cal Key Contacts (Call Center, Regional Representatives and Small Provider Billing Unit)

  • Treatment Authorization Requests (TARs) and electronic TARs (eTARs)

In addition, DHCS has developed a New Provider Checklist whereby providers will find a step-by-step checklist for building knowledge and ensuring success as a new provider. Providers are also encouraged to view and utilize the Navigating Medi-Cal and Specialty Programs chart also located on the web page.

Furthermore, providers are encouraged to subscribe to the convenient and free Medi-Cal Subscription Service (MCSS) to receive the latest policy news and program updates that are most relevant to their provider communities and subject areas of interest. Additional information about the MCSS including Frequently Asked Questions (FAQs) can be found on the MCSS Help web page.

3. FQHC/RHC Annual Rate Adjustment

Effective for dates of service on or after October 1, 2020, per federal requirements, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) received an annual rate adjustment. Under the Prospective Payment System (PPS), reimbursement rates are increased by 1.9 percent to reflect the current Medicare Economic Index (MEI).

An Erroneous Payment Correction (EPC) will be initiated to reprocess affected claims. No action is required of providers.

4. Changes to National Correct Coding Initiative October 2020 Quarterly Update

The Centers for Medicare & Medicaid Services (CMS) issued replacement files with revised procedure-to-procedure (PTP) files for the 4th quarter of 2020. The mandatory national edits were incorporated into the Medi-Cal claims processing system and were effective for dates of service on or after October 1, 2020.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess the affected claims.

For more information on NCCI and this latest update, see the National Correct Coding Initiative page on the Medicaid website.

5. Pilot Program for End Stage Renal Disease Extended Through December 31, 2021

Effective for dates of service on or after January 1, 2021, the End Stage Renal Disease Pilot Program is extended through December 31, 2021 for VillageHealth, carrier code S323.

Note: All existing billing instructions remain the same.
Provider Manual(s) Page(s) Updated
Part 1 mcp spec (7)
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
dial end (6); oth hlth (1)
Allied Health
Inpatient Services
Long Term Care
Outpatient Services
Vision Care
oth hlth (1)

6. Get the Latest Medi-Cal News: Subscribe to MCSS Today

The Medi-Cal Subscription Service (MCSS) is a free service that keeps you up-to-date on the latest Medi-Cal news. Subscribers receive subject-specific emails shortly after urgent announcements and other updates post on the Medi-Cal website.

Subscribing is simple and free!

  1. Go to the MCSS Subscriber Form

  2. Enter your email address and ZIP code and select a subscriber type

  3. Customize your subscription by selecting subject areas for NewsFlash announcements, Medi-Cal Update bulletins and/or System Status Alerts

After submitting the form, a welcome email will be sent to the provided email address. If you are unable to locate the welcome email in your inbox, check your junk email folder.

For more information about MCSS, please visit the MCSS Help page.

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