Family PACT Update

December 2021 | Bulletin 171


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1. 2022 HCPCS Annual Update

The 2022 Annual 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.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2022. Please refer to the HCPCS Level I and II code books for complete descriptions of these codes.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program modif app (10, 11)
Audiology and Hearing Aids
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics		 cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11)
Chronic Dialysis Clinics cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); path bil (6); path chem (7)
Clinics and Hospitals
General Medicine		 anest (5, 7); cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); cardio (5, 14, 15, 22, 24); chemo drug a-d (3, 7, 35, 36, 43); chemo drug e-o (13–15, 23–25); chemo drug p-z (4–7); ev woman (32); eval (10, 25, 26, 33, 34, 37, 38, 39, 44); fam planning (12); hyst (4); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); medne (10); medne neu (8); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); once (1, 9); path bil (6); path chem (7); path immun (2); path micro (3); path molec (57, 91); presum bill (6, 12); prop lab (41, 62, 63); radi dia (7, 8, 29–31); radi nuc (7); respir (7, 9); surg eye (2, 5, 7); surg muscu (7); surg nerv (11); surg integ (4); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Durable Medical Equipment
Therapies		 cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11); respir (7, 9)
Family PACT ben fam (19); office (3)
Inpatient Services cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); hyst (4); medne (10); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Obstetrics anest (5, 7); cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); ev woman (32); eval (10, 25, 26, 33, 34, 37, 38, 39, 44); fam planning (12); hyst (4); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); once (1, 9); path bil (6); path chem (7); path immun (2); path micro (3); path molec (57, 91); presum bill (6, 12); prop lab (41, 62, 63); radi dia (7, 8, 29–31); radi nuc (7); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Pharmacy cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); presum bill (6, 12)
Psychological Services cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58)
Rehabilitation Clinics cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); respir (7, 9)
Vision Care cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11); modif used vc (3); rates max optom (3)
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2. COVID-19 Global Outreach Language

On September 20, 2021, the Department of Health Care Services released a Medi-Cal Eligibility Division Information Letter (MEDIL) to provide counties, health plans, Medi-Cal providers, and other stakeholders with COVID-19 related global outreach language. The purpose of the global outreach language is to provide our partners with a tool to utilize in order to help encourage Medi-Cal beneficiaries to contact the county and report household changes and provide updated contact information. Maintaining accurate contact information allows beneficiaries to receive important information about their Medi-Cal coverage during and after the COVID-19 Public Health Emergency.

The global outreach language includes messaging that can be used for any of the following type of outreach:

  • Social Media

  • Call scripts

  • Flyers

  • Inserts

  • Websites

A link to the MEDIL can be found here: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I21-21.pdf. Providers are highly encouraged to participate in the outreach effort and utilize the global outreach language to maintain a consistent message to Medi-Cal beneficiaries about updating their contact information.

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3. J7303 Rate Update for Medi-Cal and Family PACT Programs

A rate update has been issued effective for dates of service on or after July 1, 2021, for Healthcare Common Procedure Coding System (HCPCS) level II code J7303 with
modifier U1 (NuvaRing® [etonogestrel/ethinyl estradiol vaginal ring]). The rate update is for the Medi-Cal and Family Planning Access, Care and Treatment programs (FPACT).

Refer to the table below for code and modifier combinations for their respective rates. Please note the general code descriptions included are provided to assist with interpreting and navigating the content; providers are responsible for referencing the appropriate codebooks for up-to-date full descriptions when considering which code is appropriate to bill for.

Codes Description Rate
J7303-U1 NuvaRing® (etonogestrel/ethinyl estradiol vaginal ring) $118.58

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

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4. February 2022 Medi-Cal Provider Training Webinars

Outreach and Education (O&E) along with the Department of Health Care Services (DHCS) is offering category specific webinar sessions in February.

Categories offered will include the following:

  • Eligibility: February 1, 2022.

  • Claims: February 3, 2022, and February 8, 2022.

  • Resources: February 8, 2022, and February 22, 2022.

  • Medical Services: February 17, 2022.

  • Special Claims Billing: February 10, 2022, and February 15, 2022.

  • Home Health Services: February 17, 2022.

  • Specialty Programs: February 15, 2022, and February 24, 2022.

A variety of courses will be offered in each of the categories listed. Providers must register through the Medi‑Cal Learning Portal (MLP) Event Calendar.

Providers will be able to print class materials and ask questions during the training sessions.

To view the webinars, providers must have internet access and a user profile in the MLP. Detailed instructions about the registration process and how to access webinar classes are available on the Outreach & Education page of the Medi-Cal Provider website.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

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5. March Virtual Claims Assistance Room (CAR) Event

Receive free one-on-one billing assistance at our Virtual Claims Assistance Room (CAR) Event scheduled for the month of March.

There are multiple morning and afternoon sessions available. Providers must register through the Medi Cal Learning Portal using the Event Calendar.

Reminder: First time users must complete a one-time registration. There is a link to a short video in the descriptive text under the “Provider Seminars and Webinars” tile on the Medi-Cal Learning Portal homepage, that gives directions on how to register for one of these sessions. Providers can also download the video file.

Providers are encouraged to bring their more complex billing issues and receive individual assistance from a Provider Field Representative.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

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6. Medi-Cal Rx Transition: Provider Manual, Web Pages, Removed Content and More

As the Go-Live date for Medi-Cal Rx approaches, pharmacy providers are reminded that the draft version of the Medi-Cal Rx Provider Manual was previously released to Pharmacy providers via the Provider Portal on the Medi-Cal Rx website. The draft Medi-Cal Rx Provider Manual should continue to be used for educational purposes only; the content will only be considered current billing policy on January 1, 2022.

In the interim, the Medi-Cal Manual Pharmacy sections will continue to be updated on the Medi-Cal Providers website until full implementation of Medi-Cal Rx on January 1, 2022.

Come December 31, 2021, in preparation for the full implementation of Medi-Cal Rx on January 1, 2022, the Medi-Cal Provider Manual and Medi-Cal Providers website will have all billing policy and information regarding pharmacy claims, removed or altered where appropriate. This includes, but is not limited to:

What will remain is a version of Part 2 of the Provider Manual and Medi-Cal Pharmacy community focused primarily on all professional and institutional billing policy relevant to Pharmacy providers who will continue to bill Medi-Cal for appropriate services. Providers wishing to retain the pre-carve-out version of the Medi-Cal Provider Manual for research purposes in the future, should save the manual sections to their own system by December 30, 2021.

To begin to aid the transition to the Medi-Cal Rx website, pharmacy providers may find a crosswalk of resources that currently exist on the Medi-Cal Providers website, and where similar resources will exist on the Medi-Cal Rx website, below:

Medi-Cal Provider Website Corresponding Link on Medi-Cal Rx Website
Drug Utilization Review Drug Use Review
Contract Drugs List “Covered Products List” under Forms & Information
Technical Publications “Billing Tips & Payer Sheets” and “Provider Manuals” under Forms & Information
SB393 Drug Price Inquiry This functionality will be available at a future date
NCPDP Payer Sheet Payer Sheet

Additionally, the following provider manual sections will be removed from the Medi-Cal Provider Manual on December 31, 2021:

  • Blood and Blood Derivatives (blood)

    • Note: Will be retained in other Medi-Cal Provider Manuals

  • California Children’s Services (CCS) Program Billing Example: Pharmacy Claim Forms (cal child bil ph)

  • Compound Drug Pharmacy Claim Form (30-4) Completion (compound comp)

  • Compound Pharmacy Claim Form (30-4) Examples (compound ex)

  • Drugs: Contract Drugs List Introduction (drugs cdl intr)

  • Drugs: Contract Drugs List Part 1 – Prescription Drugs (A through D) (drugs cdl p1a)

  • Drugs: Contract Drugs List Part 1 – Prescription Drugs (E through M) (drugs cdl p1b)

  • Drugs: Contract Drugs List Part 1 – Prescription Drugs (N through R) (drugs cdl p1c)

  • Drugs: Contract Drugs List Part 1 – Prescription Drugs (S through Z) (drugs cdl p1d)

  • Drugs: Contract Drugs List Part 2 – Over-the-Counter Drugs (drugs cdl p2)

  • Drugs: Contract Drugs List Part 3 – Over-the-Counter Cold/Cough Preparations (drugs cdl p3)

  • Drugs: Contract Drugs List Part 4 – Therapeutic Classifications (drugs cdl p4)

  • Drugs: Contract Drugs List Part 5 Authorized Drug Manufacturer Labeler Codes (drugs cdl p5)

  • Drugs: Contract Drugs List Part 6 – Deleted Drugs (drugs cdl p6)

  • Drugs: Contract Drugs List Part 7 – Preferred TAR-Approved Drug List (drugs cdl p7)

  • Drugs: Contract Drugs List Part 8 – Step Therapy (drugs cdl p8)

  • Drugs: Contract Drugs List Part 10 – MAIC List (drugs cdl pa10)

  • Drugs: MAIC Rate Review (drugs maic rate)

  • Form: California MAIC Rate Review Application (CAMRRA) (MC 3150)

  • Enteral Nutrition Products (enteral)

  • List of Enteral Nutrition Products (enteralnutritition.xlsx)

  • Intravenous or Intra-arterial Solutions: Administration Sets (iv sol admin)

  • Intravenous or Intra-arterial Solutions: Special Billing (iv sol spec)

  • Medicare/Medi-Cal Crossover Claims: Pharmacy Services (medi cr ph)

  • Medicare-Covered Drugs (medicare drugs)

  • Pharmacy Claim Form (30-1) Completion (pcf30-1 comp)

  • Pharmacy Claim Form (30-1) Examples (pcf30-1 ex)

  • Pharmacy Claim Form (30-1): Special Billing Instructions (pcf30-1 spec)

  • Pharmacy Claim Form (30-1) Submission and Timeliness Instructions (pcf30-1 sub)

  • Pharmacy Claim Form (30-1) Tips (pcf30-1 tips)

  • Physician-Administered Drugs (physician)

  • Reimbursement (reimbursement)

  • Reject Codes for Real-Time Internet Pharmacy (RTIP) (reject cd)

  • Share of Cost (SOC): 30-1 for Pharmacy (share ph)

  • TAR Submission: Drug TARs (tar sub drug)

Note that the following sections were previously scheduled for removal, but upon further inspection, they will be retained in the Pharmacy Provider Manual:

  • Enteral Nutrition Products (enteral)

  • List of Enteral Nutrition Products (enteralnutritition.xlsx)

  • Intravenous or Intra-arterial Solutions: Administration Sets (iv sol admin)

  • Intravenous or Intra-arterial Solutions: Special Billing (iv sol spec)

  • Reimbursement (reimbursement)

Again, manual sections that exist in multiple provider manuals will be retained where appropriate; the removal of these sections only applies to the Pharmacy Medi-Cal Provider Manual. Additionally, the following manual sections will also be added to the Pharmacy Provider Manual:

  • Medicare/Medi-Cal Crossover Claims: CMS-1500 (medi cr cms)

  • Physician-Administered Drugs – NDC (physician ndc)

  • Physician-Administered Drugs – NDC: CMS-1500 Billing Instructions (physician ndc cms)

  • Share of Cost (SOC): CMS-1500 (share cms)

And the following sections will be renamed:

  • Medicare/Medi-Cal Crossover Claims: Pharmacy Services Billing Examples (medi cr ph ex), will be renamed to:

    • Medicare/Medi-Cal Crossover Claims: CMS-1500 Billing Examples for Pharmacy (medi cr cms exp)

  • Medicare/Medi-Cal Crossover Claims: Pharmacy Services Medi-Cal Billing Pricing Examples (medi cr ph pr), will be renamed to:

    • Medicare/Medi-Cal Crossover Claims: CMS-1500 Pricing Examples for Pharmacy (medi cr cms prp)

The following CMC Billing and Technical Manual sections will also be removed:

  • NCPDP Batch Version 1.2 Pharmacy Drug Claims (ctm5010_06)

  • General Batch Transmission File Formatting (ctm5010_07)

  • Version D.Ø Transaction Information (ctm5010_08)

  • Pharmacy Billing – Request (ctm5010_09)

  • Pharmacy Billing – Responses (ctm5010_10)

  • Pharmacy Billing – Response Error Message System (ctm5010_11)

Providers wishing to retain the pre-carve-out version of the Medi-Cal Provider Manual for research purposes in the future, are once again reminded that they should save the pharmacy manual sections to their own system by December 30, 2021.

Additional Information

Providers wishing to sign up for the Medi-Cal Rx Provider Portal can find more information about enrollment in the most recent article titled “Medi-Cal Rx Web Portal Registration Training Update”.

Providers wishing to sign up for the Medi-Cal Rx Subscription Service (MCRxSS) can find more information about enrollment in the article titled “Redirect MCSS Users to Medi-Cal Rx Subscription Service”.

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7. 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.

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8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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