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Medi-Cal Update

Home Health Agencies/Home and Community-Based Services | February 2021 | Bulletin 557

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1. 2021 HCPCS Annual Update

The 2021 Quarter 1 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.

Split-bill policy for select CPT® codes will be provided in a future Medi-Cal Update.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2021. Please refer to the HCPCS Level I and II code books for complete descriptions of these codes.

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinic immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21)
Clinics and Hospitals
General Medicine
chemo drug a-d (12, 13, 32); chemo drug e-o (24–26, 31); chemo drug p-z (11, 12, 25–28); immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (23–26); modif used (1, 12–15); non inject (18–21); non ph (10, 13–16, 27); once (1); prev (9); radi dia (3, 20–22, 24); radi nuc (7)
Family PACT ben fam (3, 6, 9, 10, 32); office (1, 2, 4, 5, 7–10); pharm (3)
Home Health Agencies/Home and Community-Based Services home hlth (3); home hlth cd (1, 2)
Obstetrics immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21); non ph (10,13–16, 27); once (1); radi dia (3, 20–22, 24); radi nuc (7)
Pharmacy immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29)
Rehabilitation Clinics immun cd (1); inject cd list (2–6, 8, 11, 12, 15, 18, 20, 21, 24); inject drug a-d (3, 4, 29, 30, 39, 40); inject drug i-m (7, 11–13); inject drug n-r (21, 22); inject drug s-z (25–29); modif used (1, 12–15); non inject (18–21); non ph (10, 13–16, 27)

2. 2020 Clinical Lab Rate Updates

Effective retroactively for dates of service on or after January 1, 2020, rates for select clinical laboratory or laboratory services are adjusted to 80 percent of the lowest maximum allowance established by the federal Medicare rate program for the same or similar services, in accordance with Welfare and Institutions Code (W&I Code), Section 14105.22(b). Providers may refer to the Medi-Cal Rates page on the Medi-Cal Provider website for rates.

No action is required of providers. An Erroneous Payment Correction will be initiated to automatically correct reimbursement, as appropriate, for claims already submitted.

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4. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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