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Medi-Cal Update

Chronic Dialysis Clinics | August 2021 | Bulletin 563

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1. CLIA-waived Status Available to Certified Providers for COVID-19 Codes

Effective retroactively for dates of service on or after October 6, 2020, in accordance with the recently published Medicare Learning Network (MLN) Matters MM12318 from the Centers for Medicare & Medicaid Services (CMS), claims for CPT® code 87637 and PLA codes 0240U and 0241U may be billed with modifier QW to indicate the provider is performing the procedure using a Clinical Laboratory Improvement Amendments (CLIA)-waived test kit. Providers should ensure they have a valid, current CLIA certificate before submitting claims for these codes with the QW modifier.

Codes affected are listed below:

CPT Code Description
87637 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique
0240U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 3 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B), upper respiratory specimen, each pathogen reported as detected or not detected
0241U Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
Chronic Dialysis Clinics
General Medicine
Obstetrics
path bil (16, 17)

2. Correction: Pathology Benefit Article with Incorrect Effective Date Removed

The article New Pathology Benefits for Gene Analysis posted briefly on the Medi-Cal website on August 16, 2021. It was discovered the effective date in the article was inaccurate. The article was removed from the website and will publish at a later, more appropriate time with the correct effective date for the following services.

Code Description
81340 TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using amplification methodology (eg, polymerase chain reaction)
81341 TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to detect abnormal clonal population(s); using direct probe methodology (eg, Southern blot)
81342 TRG@ (T cell antigen receptor, gamma) (eg, leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population(s)

We are sorry for any inconvenience this has caused.

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4. Provider Manual Revisions



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