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Medi-Cal Update

Multipurpose Senior Services Program | February 2022 | Bulletin 569

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1. New COVID-19 Monoclonal Antibody Codes

Effective for dates of service on or after December 8, 2021, U.S. Food and Drug Administration (FDA) granted an Emergency Use Authorization (EUA) to a new monoclonal antibody product, Evusheld (tixagevimab co-packaged with cilgavimab) for pre-exposure prophylaxis of Coronavirus Disease 2019 (COVID-19) in adults and pediatric patients (12 years and older weighing at least 40 kg) under the conditions specified in the EUA. Evusheld is administered as two separate consecutive intramuscular injections. The Department of Health Care Services (DHCS) has established the following HCPCS codes associated with this new policy as benefits or non-benefits as applicable.

HCPCS Code Description Benefit/Non Benefit
M0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring Benefit
M0221 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the COVID-19 public health emergency Benefit
Q0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), 300mg. Non-Benefit

Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
immun (33–37); immun cd (4); inject cd list (25)
Rehabilitation Clinics immun (33–37); immun cd (4); inject cd list (25); non ph (17)
Pharmacy immun (33–37); immun cd (4); inject cd list (25); presum bill (16)

2. Additional Provider Type for ALW Nursing Facility Transition Rate Increase

Effective retroactively for dates of service on or after March 1, 2019, Assisted Living Waiver (ALW) program reimbursement rates have increased for HCPCS code G9001 (coordinated care fee, initial rate). Additional provider type Home Health Agency is now reimbursable at the new nursing facility transition rate. The reimbursement rate is updated as follows:

Code Description Provider Type Previous Rate New Rate
G9001 Coordinated care fee, initial rate Care Coordination Agency $1,000. (one-time reimbursement) $1,600. (one-time reimbursement)
G9001 Coordinated care fee, initial rate Home Health Agency $1,000. (one-time reimbursement) $1,600. (one-time reimbursement)

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

3. Modifying Acceptance and Processing of Approved LOA Documents

The current Eligibility Letter of Authorization (LOA) process will be enhanced and eventually replace forms MC 180 and MC 180-2, the current manual paper LOA process, with an electronic process for counties. This process will not replace the requirement for the provider to submit written verification of the LOA approval with the claim.

A new interim authorization document provided by the county, referred to as the county generated Notification of Eligibility for Letter of Authorization, is now an acceptable document for submission of claims for the county. LOA forms MC 180/ MC 180-2 will continue to be accepted until depletion of current county supplies. Eventually, this LOA will be enhanced to be fully electronic for the county. Until that is complete, these are the documents that will be accepted.

The county-generated Notification of Eligibility for Letter of Authorization is a temporary sample document that was shared with the counties. The counties may revise the temporary sample document as needed and submit in place of the MC 180 or MC 180-2. The revised sample document will be referred to as the County Generated Letter. This County Generated Letter may already be in use and currently submitted to the California Medicaid Management Information System (CA-MMIS) Fiscal Intermediary (FI). CA-MMIS shall accept and process the MC 180, MC 180-2, or the County Generated Letter as acceptable documentation.

For additional information please refer to the appropriate Part 2 Provider Manual sections.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Clinics and Hospitals
Chronic Dialysis Clinics
Community-Based Adult Services
Heroin Detoxification
Home Health Agencies/Home and
Community-Based Services
Hospice Care Program
Inpatient Services
Local Educational Agency
Multipurpose Senior Services Program
Rehabilitation Clinics
appeal form (2); ub sub (3, 6)
Long Term Care appeal form (2); pay ltc sub (4, 5, 7)
Acupuncture
Audiology and Hearing Aids
Chiropractic
Durable Medical Equipment
Medical Transportation
Orthotics and Prosthetics
Pharmacy
Psychological Services
Therapies
General Medicine
Obstetrics
Vision Care
appeal form (2); cms sub (4, 7)

4. May 2022 Medi-Cal Provider Training Webinars

Outreach and Education (O&E) along with the Department of Health Care Services (DHCS) are offering category specific webinar sessions in May.

Session Date
Federally Qualified Health Centers, Rural Health Clinics and Indian Health Services-Memorandum of Agreement May 3
Hospital Presumptive Eligibility May 3
Health Access Programs May 5, 10 and 12
Every Woman Counts May 12
Long Term Care May 17
Navigating the Medi-Cal Website and Online Billing May 19
Telemedicine and Virtual/Telephonic Communication Billing May 19
Allied Health May 24
Inpatient and Outpatient Services May 24 and 26
Vision Care May 26

A variety of courses will be offered in each of the categories listed. Providers must register through the Medi‑Cal Learning Portal (MLP) Event Calendar.

Providers will be able to print class materials and ask questions during the training sessions.

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

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

5. March Virtual Claims Assistance Room (CAR) Event

Receive free one-on-one billing assistance at our Virtual Claims Assistance Room (CAR) Event scheduled for the month of March.

There are multiple morning and afternoon sessions available. Providers must register through the Medi Cal Learning Portal using the Event Calendar.

Reminder: First time users must complete a one-time registration. There is a link to a short video in the descriptive text under the “Provider Seminars and Webinars” tile on the Medi-Cal Learning Portal homepage, that gives directions on how to register for one of these sessions. Providers can also download the video file.

Providers are encouraged to bring their more complex billing issues and receive individual assistance from a Provider Field Representative.

For additional assistance, please contact the Telephone Service Center (TSC) at 1-800-541-5555.

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For more information about MCSS, please visit the MCSS Help page.

7. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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