Family PACT Update

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.

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.

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.

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.

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).

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

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