Medi-Cal Logo

Medi-Cal Update

Durable Medical Equipment and Medical Supplies | May 2021 | Bulletin 548

Print Medi-Cal Update Print Icon

1. New NDC for Moderna COVID-19 Vaccine

Moderna has introduced a new National Drug Code (NDC), 80777027315, for their coronavirus disease 2019 (COVID-19) vaccine. Medi-Cal will accept and adjudicate pharmacy claims for dates of service on or after April 1, 2021, that use this NDC when billing for the administration of either dose of the Moderna COVID-19 vaccine.

The Moderna COVID-19 Vaccine web page is updated to reflect this change. All other billing policy, regardless of NDC billed, remains unchanged.

2. CCS Service Code Groupings Policy Update

The following codes will be added to or end-dated from the California Children's Services (CCS) Service Code Groupings (SCGs):

Added Codes

Effective Date Codes SCGs
January 1, 2021 Proprietary Laboratory Analyses (PLA) codes 0001A, 0002A, 0011A, 0012A and 0031A 01, 02
January 1, 2021 CPT® codes 94726 and 94729 01
January 1, 2021 CPT code 92523 05

End-Dated Codes

Effective Date CPT Codes SCGs
January 1, 2021 76970, 78135, 94250, 94400, 94750 and 94770 01
January 1, 2021 32405 and 81545 02
January 1, 2021 92585 and 92586 01, 04, 05, 06


SCG 02 includes all the codes in SCG 01, plus additional codes applicable only to SCG 02. SCG 03 includes all the codes in SCG 01 and SCG 02, plus additional codes applicable only to SCG 03. SCG 07 includes all the codes in SCG 01 plus additional codes applicable only to SCG 07.

Provider Manual(s) Page(s) Updated
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
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
Psychological Services
Rehabilitation Clinics
Vision Care
cal child ser (6, 14, 23, 24, 28, 32, 34, 36, 37)

3. Policy Update for HCPCS Code E0616

Effective for dates of service on or after June 1, 2021, HCPCS code E0616 (implantable cardiac event recorder with memory, activator and programmer) is designated as a surgical device or supply. Providers should no longer use HCPCS code E0616 to bill for services related to durable medical equipment, orthotics or prosthetics.

Previously, a frequency limit of once in a lifetime was established for HCPCS code E0616. A frequency limit is no longer applicable and modifiers NU, T1-T9, TA and UE are no longer allowed.

Provider Manual(s) Page(s) Updated
Durable Medical Transportation
Orthotics and Prosthetics
dura cd fre (3)

4. Updates to The List of Enteral Nutrition Products

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

  • Ketovie 3:1 Medi-Cal Billing Code was updated to 24359050403 (Aijnomoto Cambrooke, Inc.)

  • EquaCare Jr, Medi-Cal Billing Code 24359081108, the UPC Number per Case was updated to 324359811101 (Aijnomoto Cambrooke, Inc.)

  • Glytactin Build products, Medi-Cal Billing Codes 24359035307 and 24359053101, package sizes were updated to 15g packets and 30g packets, respectively (Aijnomoto Cambrooke, Inc.)

  • Peptamen Intense VHP products, Medi-Cal Billing Codes 43900072395 and 43900073049, the product-specific criteria was removed (Nestlé HealthCare Nutrition)

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
MS 9-17-37
P.O. Box 944243
Sacramento, CA   94244-2430
Provider Manual(s) Page(s) Updated
Allied Health
Durable Medical Equipment and Medical Supplies
enteral (1)

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:

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