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Medi-Cal Update

Local Educational Agency | April 2021 | Bulletin 559

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1. CCS Service Code Groupings Update

The following codes will be added to the California Children’s Services (CCS) Service Code Groupings (SCGs).

Added Codes

Effective Date Codes SCGs
January 15, 2021 CPT Codes 87428, 87636, 87637, 87811 and HCPCS Code G2012 01, 02
January 15, 2021 CPT Codes 96158, 96159, 96164, 96165, 96167, 96168, 96170, 96171 02
January 15, 2021 HCPCS Codes L7510, L8621, L9900 04
January 15, 2021 HCPCS Code Q4081 09

Reminder:

SCG 02 includes all the codes in SCG 01, plus additional codes applicable only to SCG 02. SCG 03 includes all the codes in SCG 01 and SCG 02, plus additional codes applicable only to SCG 03. SCG 07 includes all the codes in SCG 01 plus additional codes applicable only to SCG 07.

Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Community-Based Services
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and
Local Educational Agency
Inpatient Services
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child ser (1, 2, 21, 23, 32, 34, 46)

2. Medi-Cal Coverage Under the COVID-19 Public Health Emergency

Under the continuous coverage requirements in the federal Families First Coronavirus Response Act (FFCRA), all Medi-Cal beneficiaries are maintained in their current aid codes until end of the coronavirus disease 2019 (COVID-19) public health emergency (PHE). As a reminder, individuals in pregnancy-related aid codes continue to remain eligible for non-pregnancy services, as appropriate, under current COVID-19 PHE protections. Providers are advised to continue submitting claims with applicable diagnosis codes.

Questions concerning eligibility under pregnancy-related aid codes during PHE should be sent to pregnancy@dhcs.ca.gov.

3. 2021 HCPCS Q2 Update

The 2021 Quarter 2 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 benefits are included in the list of updates.

The code updates are effective for dates of service on or after April 1, 2021. Please refer to the HCPCS Level I and II code book for complete descriptions of these codes.

Provider Manual(s) Page(s) Updated
Audiology speech cd (2, 3)
Chronic Dialysis Clinics immun (5, 9, 12, 17–23); immun cd (1, 3); inject cd list (1, 3–5, 10, 11, 16, 21, 24); inject drug a-d (29); inject drug e-h (55–57); inject drug i-m (7, 23, 24, 34, 35); inject drug s-z (26–29); modif used (11–14); non ph (10, 13–15, 30)
Clinics and Hospitals
General Medicine
chemo drug a-d (13, 22–24); chemo drug p-z (27, 28); immun (5, 9, 12, 17–23); immun cd (1, 3); inject cd list (1, 3–5, 10, 11, 16, 21, 24); inject drug a-d (29); inject drug e-h (55–57); inject drug i-m (7, 23, 24, 34, 35); inject drug s-z (26–29); medne tele (10, 12); modif used (11–14); non ph (10, 13–15, 30); presum bill (19); prop lab (1, 22, 57–59); radi dia (22); radi nuc (7); surg urin (5); tar and non cd0 (32)
Community-Based Adult Services
Therapies
occu cd (1); once (1–3); phys cd (3); speech cd (2, 3)
Inpatient Services tar and non cd0 (32)
Obstetrics immun (5, 9, 12, 17–23); immun cd (1, 3); inject cd list (1, 3–5, 10, 11, 16, 21, 24); inject drug a-d (29); inject drug e-h (55–57); inject drug i-m (7, 23, 24, 34, 35); inject drug s-z (26–29); modif used (11–14); non ph (10, 13–15, 30); presum bill (19); prop lab (1, 22, 57–59); radi dia (22); radi nuc (7); surg urin (5); tar and non cd0 (32)
Pharmacy immun (5, 9, 12, 17–23); immun cd (1, 3); inject cd list (1, 3–5, 10, 11, 16, 21, 24); inject drug a-d (29); inject drug e-h (55–57); inject drug i-m (7, 23, 24, 34, 35); inject drug s-z (26–29); presum bill (19)
Rehabilitation Clinics immun (5, 9, 12, 17–23); immun cd (1, 3); inject cd list (1, 3–5, 10, 11, 16, 21, 24); inject drug a-d (29); inject drug e-h (55–57); inject drug i-m (7, 23, 24, 34, 35); inject drug s-z (26–29); modif used (11–14); non ph (10, 13–15, 30); occu cd (1); once (1–3); phys cd (3); speech cd (2, 3)

4. State Plan Amendment 16-001: Eligible TCM Population Expanded

Local Educational Agency (LEA) providers may begin submitting claims for the new SPA 16-001 practitioner types (modifiers) for dates of service on or after July 1, 2020:

  • Licensed speech-language pathologists (GN)

  • Credentialed speech-language pathologists (GN)

  • Licensed occupational therapists (GO)

  • Licensed physical therapists (GP)

SPA 16-001 expands the population of students eligible to receive Targeted Case Management (TCM) services beyond those students with an Individualized Education Plan (IEP) or Individualized Family Services Plan (IFSP). Under SPA 16-001, LEAs may receive reimbursement for general education students who have TCM services identified in an Individualized Health and Support Plan (IHSP) or other care plan.

Additional information about the expanded student population, service limitation restrictions and allowable units of service that apply to each service is available in the Part 2, Local Educational Agency (LEA) Service: Targeted Case Management manual section.

Retroactive TCM Claim Submission

SPA 16-001 has a retroactive effective date of January 2, 2016; however, at this time the Department of Health Care Services (DHCS) instructs LEAs not to submit claims for services rendered prior to July 1, 2020. In a forthcoming Policy and Procedure Letter (PPL), DHCS will provide instructions for services rendered January 2, 2016, through June 30, 2020.

Other important LEA billing updates were published in last month’s LEA Medi-Cal Update in the article “State Plan Amendment Updates: New LEA Practitioner Types, Services and Rates.”

5. Claim Submission Timeliness Override for New LEA Services

A recent Medi-Cal Update announced new Local Educational Agency (LEA) practitioner types, services and rates. The article instructed providers that as of March 16, 2021, LEAs could begin submitting claims for the new SPA 15-021-related services and practitioner types for dates of service on or after July 1, 2020.

Practitioners are now notified there is a six-month timeliness override for claims with dates of service on July 1, 2020, through June 30, 2021. The timeliness override begins on July 1, 2021, and extends through December 31, 2021. The six-month timeliness override will allow LEA claims with dates of service in state fiscal year 2020 – 2021 to be paid through December 31, 2021.

For policy details about the new LEA services, practitioner types and rates, providers may refer to the State Plan Amendment Updates: New LEA Practitioner Types, Services and Rates article in the March 16, 2021, Local Educational Agency Medi-Cal Update. The article includes various charts with locator keys of the Part 2, LEA provider manual sections where policy for the new services and provider types are located and the modifiers providers must include on claims to identify the new group of qualified LEA rendering practitioners.

Reminder: Retroactive Claim Submission

SPA 15-021 has an effective date of July 1, 2015; however, at this time the Department of Health Care Services (DHCS) instructs LEAs not to submit claims for services rendered prior to July 1, 2020. In a forthcoming Policy and Procedure Letter (PPL), DHCS will provide instructions for services rendered July 1, 2015 through June 30, 2020.

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7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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