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Medi-Cal Update

Durable Medical Equipment and Medical Supplies | October 2021 | Bulletin 553

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1. 2021 HCPCS Q4 Update Additional Information Available

A previously published Medi-Cal Update added, changed and deleted Current Procedural Terminology – 4th Edition (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes for the 2021 Quarter 4 update, effective October 1, 2021. Additional manual pages reflecting these changes are now available.

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
modif used (4, 12–16); surg integ (6)
Dialysis Clinics
Rehabilitation Clinics
modif used (4, 12–16)
Durable Medical Equipment
Therapies
ortho cd2 (5); ortho cd fre2 (1)
Orthotics and Prosthetics
Pharmacy
ortho auth pros (14, 15); ortho cd2 (5); ortho cd fre2 (1)

2. 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)

3. New Rectal Catheter Code Added Effective November 1, 2021

Effective for dates of service on or after November 1, 2021, HCPCS code A4453 (Rectal catheter for use with the manual pump-operated enema system, replacement only) is added as a medical supply billing code, requiring a Treatment Authorization Request (TAR), on the List of Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet.

In addition to TAR approval, claims submitted using HCPCS code A4453 require documentation of product cost (an invoice, manufacturer’s catalog page or price list) attached to the claim for reimbursement. HCPCS code A4453 is used in conjunction with HCPCS code A4459 (manual pump-operated enema system, includes balloon, catheter and all accessories, reusable, any type).

Effective for dates of service on or after January 1, 2022, claims with approved TARs using HCPCS code T5999 (supply, not otherwise specified) for reimbursement of a manual pump-operated enema system and its accessories will be denied.

4. 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.

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6. Provider Manual Revisions



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