Family PACT Update

May 2021 | Bulletin 164


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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. Family PACT Updates Cefixime Pharmacy Dispensing

Effective for dates of service on or after June 1, 2021, the maximum allowable dosage for Cefixime has increased from 2,400 mg to 4,800 mg per dispensing.

This update is in accordance with the Centers for Disease Control and Prevention (CDC) policy, “Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020” published in December 2020.

Provider Manual(s) Page(s) Updated
Family PACT pharmacy (3)

3. Gonorrhea Treatment Update for Family PACT and Medi-Cal

Effective for dates of service on or after June 1, 2021, the Department of Health Care Services (DHCS) is updating the treatment of uncomplicated gonorrhea in adolescents and adults for Family Planning Access, Care and Treatment (Family PACT) and Medi-Cal programs in accordance with the Centers for Disease Control and Prevention (CDC) guidelines titled Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020.

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
Obstetrics
fam planning (26, 27)
Family PACT ben grid (35, 36, 38–40); clinic (3)

4. BCCTP Applicants Granted Presumptive Eligibility

In the continued effort to align all Presumptive Eligibility (PE) Programs, Breast and Cervical Cancer Treatment Program (BCCTP) applications granted PE will populate in the Medi-Cal Eligibility Data System (MEDS) with an automated termination date of the end of the following month. As soon as the applicant fulfills the requirement to apply for full-scope Medi-Cal benefits from their county, this termination date will drop off and they will continue in PE until BCCTP makes the continuing eligibility decision. Also, the plastic Benefits Identification Card (BIC) will be issued when BCCTP makes the continuing eligibility decision. The “Confirmation Document” that is generated when Every Woman Counts (EWC) and Family Planning, Access, Care and Treatment (Family PACT) providers submit a BCCTP Enrollment Application should be used to obtain services by Medi-Cal providers during the PE period.

Providers are expected to hand-deliver, email or mail out to a BCCTP applicant, the “Confirmation Document” and the “Directions to Apply for Medi-Cal” that are generated together when the application is submitted. The “Confirmation Document” tells the applicants if they were granted PE and gives them their BIC number so they can obtain services. The “Directions of Apply for Medi-Cal” explains what the applicants must do in order for their benefits to continue beyond the end of the following month and serves as a notification that the benefits will terminate if they do not comply.

Questions concerning BCCTP PE should be sent to BCCTP@dhcs.ca.gov.

5. Updated Rates for Select Physician Administered Drugs

Effective for dates of service on or after January 1, 2021, rates are updated for claims billed with HCPCS code J3490 (unclassified drugs) and modifier U6 (levonorgestrel) or U8 (medroxyprogesterone acetate).

Procedure Code with Modifier Description Rate
J3490 U6 Levonorgestrel, 1.5 mg $13.85
J3490 U8 Medroxyprogesterone acetate, 150 mg $64.61

Providers should refer to the Medi-Cal Rates page of the Medi-Cal website for general rates information.

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