Medi-Cal Logo

Medi-Cal Update

Durable Medical Equipment and Medical Supplies | February 2021 | Bulletin 545

Print Medi-Cal Update Print Icon

1. 2021 HCPCS Annual Update

The 2021 Quarter 1 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the HCPCS Policy Updates PDF. Only those codes representing current and past Medi-Cal and Family Planning, Access, Care and Treatment (FPACT) benefits are included in the list of updates.

Split-bill policy for select CPT® codes will be provided in a future Medi-Cal Update.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2021. Please refer to the HCPCS Level I and II code books for complete descriptions of these codes.

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinic immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21)
Clinics and Hospitals
General Medicine
chemo drug a-d (12, 13, 32); chemo drug e-o (24–26, 31); chemo drug p-z (11, 12, 25–28); immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (23–26); modif used (1, 12–15); non inject (18–21); non ph (10, 13–16, 27); once (1); prev (9); radi dia (3, 20–22, 24); radi nuc (7)
Family PACT ben fam (3, 6, 9, 10, 32); office (1, 2, 4, 5, 7–10); pharm (3)
Home Health Agencies/Home and Community-Based Services home hlth (3); home hlth cd (1, 2)
Obstetrics immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21); non ph (10,13–16, 27); once (1); radi dia (3, 20–22, 24); radi nuc (7)
Pharmacy immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29)
Rehabilitation Clinics immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21); non ph (10, 13–16, 27)

2. 2020 Clinical Lab Rate Updates

Effective retroactively for dates of service on or after January 1, 2020, rates for select clinical laboratory or laboratory services are adjusted to 80 percent of the lowest maximum allowance established by the federal Medicare rate program for the same or similar services, in accordance with Welfare and Institutions Code (W&I Code), Section 14105.22(b). Providers may refer to the Medi-Cal Rates page on the Medi-Cal Provider website for rates.

No action is required of providers. An Erroneous Payment Correction will be initiated to automatically correct reimbursement, as appropriate, for claims already submitted.

3. Updates to The List of Contracted Incontinence Absorbent Products

Effective for dates of service on or after February 1, 2021, Cardinal’s bladder control pad, item number 1100B is reinstated as a contracted product on the List of Contracted Incontinence Absorbent Products.

4. Revised Updates to The List of Enteral Nutrition Products Effective for Dates of Service on or After January 1, 2021

Effective for dates of service on or after January 1, 2021, the following changes apply to the List of Enteral Nutrition Products Effective for Dates of Service on or After January 1, 2021.

  • PediaSure Grow & Gain with and without Fiber, Bottles (4 products), billing codes 70074067532, 70074067534, 70074067536, 70074067538, were added with a MAC price of 0.0061. These product numbers were also removed from the Deletions tab of the List.

  • Enfamil Neuro Pro EnfaCare 22 RTU, case 48 UPC Case Number has been updated to 300875122051

  • PurAmino Jr. 400g, vanilla Medi-Cal Billing Code (NDC-like number) has been updated to 00087512244

  • MCT Procal, unflav, 30x16g sachets, billing code 50600050236, was added to the Specialized product category. Previously, it was only listed as a Metabolic product

  • Product Types revised to ensure alignment with the category criteria in the Provider Manual.

Product-Specific Criteria removed or updated for most products on the List. Please refer to the List of Enteral Nutrition Products Effective for Dates of Service on or After January 1, 2021 for specific product changes.

Note: Listing of a product is not a guarantee of its availability. The product number approved on an authorization must be the same product number dispensed to the beneficiary and claimed for reimbursement by the provider.

The amount reimbursed to providers for enteral nutrition products shall not exceed the published estimated acquisition cost (EAC) plus a 23 percent markup.

Medi-Cal beneficiaries denied enteral nutrition products who believe the denial was in error may ask for a state hearing by contacting the California Department of Social Services at 1-800-743-8525 or 1-855-795-0634 or by sending a written request to:

California Department of Social Services
State Hearings Division
P.O. Box 944243, MS 9-17-37
Sacramento, CA  94244-2430

5. 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.

6. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



Note:
Download PDF (Portable Document Format) reader from the Web Tool Box.