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Medi-Cal Update

AIDS Waiver Program | October 2021 | Bulletin 565

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1. Updated Policy for Palivizumab for the 2021–2022 RSV Season

Effective for dates of services on or after August 19, 2021, and continuing for the 2021–2022 respiratory syncytial virus (RSV) season only, county RSV positivity data for the time period reflecting the administered dose of Palivizumab (CPT® code 90378 [respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each]) is no longer required to be accompanied with a Treatment Authorization Request (TAR) for doses submitted outside the time period of a typical RSV season such as 2019–2020. Additional information can be found below.

Resources:

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitations Clinics
immun (62, 64)

2. Medi-Cal Rates Adjustment

Effective for dates of service on or after October 1, 2021, Medi-Cal rates have been adjusted to adhere to requirements mandated by the Centers for Medicare and Medicaid Services (CMS).

The updated Medi-Cal rates are available on the Medi-Cal Rates page.

3. Updates to Facility Types for Outpatient Billing

Effective for dates of service on or after November 1, 2021, facility type code “02” (services provided or received through a telecommunication system) is no longer allowable on Medi-Cal claims. When billing for telehealth services, providers should report the Type of Bill code that most accurately reflects the type of facility submitting a claim for the service and report the appropriate claim frequency code as defined by the National Uniform Billing Committee (NUBC) UB-04 Data Specifications Manual.

Additionally, several outpatient facility type definitions have been updated. Refer to the UB-04 Completion: Outpatient Services in the Part 2 Medi-Cal Provider Manual for updated definitions.

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
medne tele (5); ub comp op (4, 5, 8)
AIDS Waiver Program
Chronic Dialysis Clinics
Community-Based Adult Services
Heroin Detoxification
Home Health Agencies/Home and
Community-Based Services
Hospice
Local Educational Agency
Multipurpose Senior Services Program
Rehabilitation Clinics
ub comp op (4, 5, 8)

4. 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, 2021
NDC Labeler Code      Contracting Company's Name
65038Corium, Inc.
71921Florida Pharmaceutical Products, LLC
72664Vgyaan Pharmaceuticals
72730QED Therapeutics, Inc.
73059Shield Therapeutics
73317Aum Pharmaceuticals.
73606APL Sales I LLC
73607Amivas (US), LLC
74528Albireo Pharma, Inc.
75788Scynexis, Inc.
78206Organon, LLC
79802Kadmon Pharmaceuticals, LLC
81561Porton Biopharma Limited
  
Terminations, effective October 1, 2021
NDC Labeler Code      Contracting Company's Name
66621Rare Disease Therapeutics, Inc.
70720Tersera Therapeutics, LLC
89141Midatech Pharma US, Inc.
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 (15, 19–23)

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6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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