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Medi-Cal Update

Local Educational Agency | October 2021 | Bulletin 565

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1. Updated Policy for Palivizumab for the 2021–2022 RSV Season

Effective for dates of services on or after August 19, 2021, and continuing for the 2021–2022 respiratory syncytial virus (RSV) season only, county RSV positivity data for the time period reflecting the administered dose of Palivizumab (CPT® code 90378 [respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each]) is no longer required to be accompanied with a Treatment Authorization Request (TAR) for doses submitted outside the time period of a typical RSV season such as 2019–2020. Additional information can be found below.

Resources:

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitations Clinics
immun (62, 64)

2. State Plan Amendment Updates: LEA Nursing and Psychological Services Updated

The Local Educational Agency (LEA) Medi-Cal Billing Option Program (BOP) is adding clarification edits related to LEA nursing and psychological services. LEA BOP is updating the reimbursable services section of LEA psychological services to include IEP/IFSP psychosocial status assessments as reimbursable services for credentialed school counselor (not previously included in the March 2021 Medi-Cal Update). The LEA BOP is also clarifying billable assessments and treatments and supervision requirements for LEA nursing services.

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.

Provider Manual(s) Page(s) Updated
Local Educational Agency loc ed serv nurs (3, 4, 10); loc ed serv psych (2)

3. State Plan Amendment Updates: LEA Hearing and Speech Therapy Services Updated

Based on State Plan Amendment (SPA) 15-021, the Local Educational Agency (LEA) Medi-Cal Billing Option Program (BOP) is adding additional qualified practitioners and telehealth services to LEA hearing and speech therapy services.

For policy details on SPA 15-021 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.

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.

Provider Manual(s) Page(s) Updated
Local Educational Agency loc ed serv hear (1–10); loc ed serv spe (1–20)

4. LEA Billing Option Program Reminder for Type of Bill Information

Due to an inaccuracy in the Medi-Cal Provider Manual, some LEA Billing Option Program (BOP) providers submitted claims with Place of Service information in the Type of Bill field, causing those claims to deny with RAD code 0062: The Place of Service is not acceptable for this procedure. LEA BOP providers are instructed to rebill incorrectly denied claims and enter the two-digit facility type code “89” (special facility – other) and one-character claim frequency code “1” as “891” in the Type of Bill field on the UB-04 claim form, effective January 1, 2020.

Provider Manual(s) Page(s) Updated
Local Educational Agency loc ed bil (12)

5. Medi-Cal Rates Adjustment

Effective for dates of service on or after October 1, 2021, Medi-Cal rates have been adjusted to adhere to requirements mandated by the Centers for Medicare and Medicaid Services (CMS).

The updated Medi-Cal rates are available on the Medi-Cal Rates page.

6. Updates to Facility Types for Outpatient Billing

Effective for dates of service on or after November 1, 2021, facility type code “02” (services provided or received through a telecommunication system) is no longer allowable on Medi-Cal claims. When billing for telehealth services, providers should report the Type of Bill code that most accurately reflects the type of facility submitting a claim for the service and report the appropriate claim frequency code as defined by the National Uniform Billing Committee (NUBC) UB-04 Data Specifications Manual.

Additionally, several outpatient facility type definitions have been updated. Refer to the UB-04 Completion: Outpatient Services in the Part 2 Medi-Cal Provider Manual for updated definitions.

Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
medne tele (5); ub comp op (4, 5, 8)
AIDS Waiver Program
Chronic Dialysis Clinics
Community-Based Adult Services
Heroin Detoxification
Home Health Agencies/Home and
Community-Based Services
Hospice
Local Educational Agency
Multipurpose Senior Services Program
Rehabilitation Clinics
ub comp op (4, 5, 8)

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8. Provider Manual Revisions



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