Medi-Cal Update

Long Term Care | August 2020 | Bulletin 522

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1. Provider Manuals are Becoming ADA Compliant

During August and September 2020, Medi-Cal provider manuals are being remediated to be compliant with Assembly Bill (AB) 434, which requires compliance with the Americans with Disabilities Act (ADA) standards. Provider manual sections will be published on the Medi-Cal Provider website as usual. Providers may encounter a mix of old and new formatting for individual manual sections of a provider manual. These changes affect the manual format and are not policy changes. Remediation of the manuals will be complete upon release of the September provider bulletins and manuals.

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2. CCS Service Code Groupings Update for COVID-19 Services

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

Added Codes
Effective Date Codes SCGs
March 1, 2020 CPT® codes 86328, 86769, 87426, 87635 and HCPCS codes C9083, G2023, G2024, U0001, U0002, U0003 and U0004 01, 02

Reminder: SCG 02 includes all the codes in SCG 01, plus additional codes applicable only to SCG 02.

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3. New CPT® Code for COVID-19 Testing Added as a Medi-Cal Benefit

Effective for dates of service on or after June 25, 2020, the American Medical Association created a new code for reporting antigen testing of patients suspected of being infected with the coronavirus disease 2019 (COVID-19). CPT® code 87426 is intended for use as the industry standard for accurate reporting and tracking of antigen tests using immunofluorescent or immunochromatographic technique for the detection of biomolecules produced by COVID-19. This code is a Medi-Cal benefit.

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4. New Policy Changes to the Hospital Presumptive Eligibility Program

As California continues to respond to coronavirus disease 2019 (COVID-19), the Hospital Presumptive Eligibility (HPE) Program will temporarily expand presumptive eligibility (PE) coverage to a new coverage group of individuals who are 65 or older and whose income is below 138 percent of the Federal Poverty level (FPL), effective immediately. This new coverage group is referred to as the “Aged” HPE group. This coverage group is allowed two (2) periods of PE in a twelve-month period and will be assigned aid code 7D. This expansion will be in effect through the end of the COVID-19 public health emergency.

DHCS is also expanding presumptive eligibility periods through HPE for adults that are age 19 years and over. HPE will now provide two (2) periods of presumptive eligibility in a twelve-month period for adults age 19 and over. This change is effective immediately and will be in effect through the end of the COVID-19 public health emergency.

DHCS has received federal approval on these new policy changes through California State Plan Amendment 20-0024.

It is critical that HPE Providers monitor the Hospital PE Program Medi-Cal website for future articles and materials scheduled to publish during May and June 2020.

Questions concerning the HPE expansion should be sent to

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5. Telephone Service Center Release of Provider Identification Number Guidelines

The Department of Health Care Services (DHCS) is implementing process changes which will allow authorized telephone agents within the Telephone Service Center (TSC) to release an existing Provider Identification Number (PIN) to a provider upon request.

Providers need a PIN in order to access various Medi-Cal applications, such as the Automated Eligibility Verification System (AEVS) and the Provider Telecommunications Network (PTN), as well as Transaction Services (secured area on the Medi-Cal Provider Website). In the instance when a provider does not remember their PIN, TSC technical help desk agents are authorized to release the existing PIN once caller validation protocols have been completed.

As PIN release is governed by discrete caller validation protocols, there are circumstances in which the TSC technical help desk agent may only be authorized to re-issue the PIN letter with the existing PIN. If this is authorized, the PIN letter will be sent to the provider’s Pay-To address on file.

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6. 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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