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Medi-Cal Update

Hospice Care Program | December 2020 | Bulletin 555

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1. 2021 CPT® Annual Update

The 2021 Quarter 1 updates to the Current Procedural Terminology (CPT) codes are available in the December 2020 CPT Policy Updates PDF. Only those codes representing current or future Medi-Cal benefits are included in the list of updates.

The code additions, changes and deletions are effective for the dates of service on or after January 1, 2021. Please refer to the 2021 CPT code book for complete code descriptions.

The 2021 Quarter 1 updates to the Healthcare Common Procedure Coding System (HCPCS) Level II codes are also effective for Medicare on January 1, 2021. However, due to a delay caused by the coronavirus disease 2019 (COVID-19), Medi-Cal is not able to adopt the updates in time to publish the associated policy in the January Medi-Cal Update.

Providers should not use the 2021 Quarter 1 HCPCS Level II codes to bill for Medi-Cal or Presumptive Eligibility for Pregnant Women (PE4PW) services until notified to do so in a future Medi-Cal Update.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program modif app (10, 11)
Audiology and Hearing Aids audio (4); cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11)
Chronic Dialysis Clinics cal child ser (1, 25, 34, 36, 37, 50, 56); immun (31); immun cd (1); modif app (10, 11); modif used (3, 4, 6–8, 10, 12)
Clinics and Hospitals
General Medicine
cal child ser (1, 25, 34, 36, 37, 50, 56); cardio (3); eval (2, 4–7, 9, 13, 14, 27, 29); ev woman (24, 31, 32); fam planning (6, 9, 10, 12); hyst (3); immun (31); immun cd (1); medne neu (5); medne oto (1); medne pul (4); modif app (10, 11); modif used (3, 4, 6–8, 10, 12); non ph (9, 11, 25, 27); once (7); ophthal (2, 3, 12); path molec (9, 16, 17, 30, 43–47, 51, 52, 56, 60, 70, 93); preg determ (1); preg early (5); preg glo (4); preg per (2); preg post (6); presum bill (1, 2, 4, 9, 10, 11, 12, 16); prev (2, 3, 6, 8, 9); psych (4); radi (5); radi dia (3); radi onc (1); rates max (5); respir (4); spec (2); surg aud (5); surg bil mod (7, 8); surg cardio (3, 10); surg muscu (2); surg nerv (1); tar and non cd1 (8, 21–23); tar and non cd2 (32, 33); tar and non cd3 (13); tar and non cd5 (25, 28, 30, 33); tar and non cd6 (4, 9, 31); tar and non cd8 (3, 5, 7, 8, 10, 12, 13, 14); tar and non cd9 (4, 5, 6, 36)
Community Based Services audio (4)
Durable Medical Equipment cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11); respir (4)
Home Health Agencies/Home and Community-Based Services cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11); preg post (6)
Inpatient Services cal child ser (1, 25, 34, 36, 37, 50, 56); hyst (3); preg post (6); tar and non cd1 (8, 21–23); tar and non cd2 (32, 33); tar and non cd3 (13); tar and non cd5 (25, 28, 30, 33); tar and non cd6 (4, 9, 31); tar and non cd8 (3, 5, 7, 8, 10, 12, 13, 14); tar and non cd9 (4, 5, 6, 36)
Local Education Agency
Medical Transportation
Orthotics and Prosthetics
cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11)
Obstetrics cal child ser (1, 25, 34, 36, 37, 50, 56); eval (2, 4–6, 8, 12, 13, 26, 28); ev woman (24, 31, 32); fam planning (6, 9, 10, 12); hyst (3); immun (31); immun cd (1); modif app (10, 11); modif used (3, 4, 6–8, 10, 12); non ph (9, 11, 25, 27); once (7); path molec (9, 16, 17, 30, 43–47, 51, 52, 56, 60, 70, 93); preg determ (1); preg early (5); preg glo (4); preg per (2); preg post (6); presum bill (1, 2, 4, 9, 10, 11, 12, 16); radi (5); radi dia (3); radi onc (1); rates max (5); surg bil mod (7, 8); tar and non cd1 (8, 21–23); tar and non cd2 (32, 33); tar and non cd3 (13); tar and non cd5 (25, 28, 30, 33); tar and non cd6 (4, 9, 31); tar and non cd8 (3, 5, 7, 8, 10, 12, 13, 14); tar and non cd9 (4, 5, 6, 36)
Pharmacy cal child ser (1, 25, 34, 36, 37, 50, 56); immun (31); immun cd (1); pharm serv (2–7, 10); presum bill (1, 2, 4, 9, 10, 11, 12, 16)
Psychological Services cal child ser (1, 25, 34, 36, 37, 50, 56); psychol (6); psychol cd (1); spec (2)
Rehabilitation Clinics audio (4); cal child ser (1, 25, 34, 36, 37, 50, 56); immun (31); immun cd (1); modif app (10, 11); modif used (3, 4, 6–8, 10, 12); non ph (9,11, 25, 27); respir (4)
Therapies audio (4); cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11); respir (4)
Vision Care cal child ser (1, 25, 34, 36, 37, 50, 56); modif app (10, 11); pro serv (3, 9, 11, 12, 19); rates max optom (2–4)

2. Medi-Cal Lengthens Transition Time to Full Implementation – Go-Live on April 1, 2021

Given the ongoing challenges and constantly evolving health care landscape associated with the unprecedented coronavirus disease 2019 (COVID-19) public health emergency (PHE), the Department of Health Care Services (DHCS), in partnership and collaboration with Magellan Medicaid Administration, Inc. (Magellan), has decided to lengthen the time for the full implementation of the transition to Medi-Cal Rx by three  months. DHCS and Magellan will continue to dedicate their combined efforts and rigorous preparations towards Assumption of Operations (AOO) for Medi-Cal Rx on April 1, 2021. In the interim, all current processes and protocols, both effectuated by DHCS and our Medi-Cal managed care plans (MCPs), respectively, will remain unchanged and in place until Medi-Cal Rx launches.

While neither DHCS nor Magellan takes this decision lightly, we are confident that given the COVID-19 PHE, this decision is in the best interests of our Medi-Cal beneficiaries and providers. Lengthening the time for full implementation will help to ensure a more complete transition, as well as mitigate impacts to beneficiaries in accessing their medication. Moving the launch of Medi-Cal Rx to April 1, 2021, will provide additional and valuable opportunities for Medi-Cal providers, beneficiaries, MCPs, and other interested parties to become better acclimated to, and familiar with new Medi-Cal Rx policies and processes, through additional messaging from DHCS and Magellan, additional targeted stakeholder engagement and outreach efforts and additional provider trainings.

Please note that DHCS will be working to update applicable provider guidance and associated Medi-Cal Rx provider bulletins/Newsflash articles in the coming weeks to reflect the April 1, 2021, go-live date. With the exception of the three-month shift in the go-live date, all other aspects of the transition communicated to our providers via bulletins through the Medi-Cal and Medi-Cal Rx websites remain unchanged.

DHCS appreciates your continued support and collaboration relative to this important project and looks forward to the successful launch and AOO of Medi-Cal Rx on April 1, 2021. If you have any questions about this notification, please feel free to direct them to the Medi-Cal Rx Project Team at RxCarveOut@dhcs.ca.gov.

3. National Correct Coding Initiative Quarterly Update for January 2021

The Centers for Medicare & Medicaid Services (CMS) has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates. These mandatory national edits have been incorporated into the Medi-Cal claims processing system and are effective for dates of service on or after January 1, 2021.

For additional information, refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website.

4. January Through February 2021 Medi-Cal Provider Training Webinars

Beginning January 5, 2021 and continuing throughout the month of February, Medi-Cal providers may participate in provider training webinars that are:

  • Held twice a day on Tuesdays and Thursdays at 10:00 a.m. and 2:00 p.m.

  • Hosted in real-time by a Medi-Cal Regional Representative

  • Designed to cover basic, advanced and specialty billing topics

Registration for the training webinars is available on the Medi-Cal Learning Portal (MLP) or the Medi-Cal home page.

Providers will be able to print class materials and ask questions during the live webinar training sessions. The MLP offers training courses that can be viewed according to your schedule if you are unable to attend one of the live webinars.

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

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