Medi-Cal Update

Medical Transportation | October 2020 | Bulletin 541

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1. COVID-19 Quantitative Antibody Test Added as a Medi-Cal Benefit

Effective for dates of service on or after September 8, 2020, CPT® code 86413 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)] antibody, quantitative) is added as a Medi-Cal benefit.

CPT code 86413 may be billed with any ICD-10-CM code.

An Erroneous Payment Correction (EPC) will be processed for affected claims.

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2. October 2020 HCPCS Quarterly Update

The October 2020 updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the October 2020 HCPCS 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 October 1, 2020. Please refer to the 2020 HCPCS code book for complete code descriptions.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Audiology and Hearing Aids
Durable Medical Equipment
Home Health Agencies/Home and Community-Based Services
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
medi non hcp (2); modif app (13, 26)
Chronic Dialysis Clinics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15)
General Medicine
Clinics and Hospitals
chemo drug a-d (30, 31); chemo drug e-o (20, 29); chemo drug p-z (7–9, 20–23); inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27); ophthal (24); presum bill (12, 14–16); radi dia (21–25); surg digest (7); surg integ (4, 6); surg urin (5, 7)
Heroin Detoxification
Hospice Care Program
Psychological Services
medi non hcp (2)
Local Educational Agency modif app (13, 26)
Obstetrics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27); presum bill (12, 14–16); radi dia (21–25); surg urin (5, 7)
Pharmacy inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); presum bill (12, 14–16)
Rehabilitation Clinics inject cd list (3, 4, 6, 9, 13, 15, 18, 20); inject drug a-d (17, 18, 25, 26); inject drug e-h (15, 16); inject drug i-m (26); medi non hcp (2); modif app (13, 26); modif used (5, 6, 12–15); non ph (10, 13–15, 25, 27)
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3. Medi-Cal Business Operations Fiscal Intermediary Name Change

Effective October 1, 2020, providers may notice that the Department of Health Care Services (DHCS) California Medicaid Information System (CA-MMIS) Fiscal Intermediary (FI) for the Medi-Cal program, formerly DXC, LLC, is operating under a new company name, “Gainwell Technologies.” Operations and interactions with providers are not impacted by this FI name change. There are no changes in the telephone numbers used by providers, including the Telephone Service Center (TSC) number (1-800-541-5555), as a result of this name change. The mailing addresses used by providers to conduct business with DHCS and the FI will remain the same as well.

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4. Fiscal Intermediary Technology Refresh Implementation

As previously announced in a July 16, 2020 article, DXC Technology, the Business Operations Fiscal Intermediary (FI), has staged the deployment of various business oriented IT solutions to occur July 2020 onward.

As of August 2020, the following technological refreshes have already been implemented:

On September 14, 2020, the remaining technological refreshes are scheduled to be live in production:

As with the initial operational transition in October 2019, and the first wave of technical changes in August 2020, the primary objective is a successful transition without disruption to state programs, providers and/or members (beneficiaries). Given the type of IT services slated for the second wave of technological changes, providers and members may notice differences in processes and/or may experience longer call wait times pre- and post-implementation as the operations prepare for deployment and stabilize.

The Department of Health Care Services (DHCS) will continue to provide updates as this effort progresses. Please continue to monitor the Medi-Cal Provider website for future updates on this topic.

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5. CCS and GHPP 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 1, 2020 CPT® codes 76391, 76978, 76979, 76981 thru 76983, 77046 thru 77049, 78429 01, 02
January 1, 2020 CPT codes 46948, 78430 thru 78835, 81173, 81174, 81177 thru 81190, 81204, 81234, 81236, 81237, 81239, 81277, 81284 thru 81286, 81289, 81305, 81306, 81329, 81336, 81337, 81343 thru 81345, 81443, 81596, 82642, 83722, 87563, 90619, 93264, 93356, 95700, 95705 thru 95726, 95782, 95783, 95836, 95976, 95977, 95983, 95984, 99458, 99473, 99474
HCPCS code A9513
01, 02, 03
January 1, 2020 CPT codes 10004 thru 10012, 15769, 15771 thru 15774, 20560, 20561, 20700 thru 20705, 36572, 36573, 38531, 43762, 43763, 49013, 49014, 62328, 62329, 64451, 64454, 64624, 64625, 74221, 74248, 87633, 90689, 90694, 92549, 99421 thru 99423, 99451 thru 99454, 99457, 99491
HCPCS codes A4216, A9590, J0121, J0122, J0185, J1095, J3304
01, 02, 03, 07
January 1, 2020 CPT codes 11102 thru 11107 01, 02, 03, 07, 12
January 1, 2020 CPT code 27369 01, 07
January 1, 2020 HCPCS code A9589 02
January 1, 2020 CPT codes 33016 thru 33019, 33274, 33275, 33285, 33286, 33289, 50436, 50437 02, 03
January 1, 2020 CPT codes 35702, 35703 02, 03, 07
January 1, 2020 CPT codes 96130 thru 96133 HCPCS code J1454 03
January 1, 2020 CPT codes 96112, 96113, 96121 03, 05, 06
January 1, 2020 CPT codes 20932 thru 20934 HCPCS code C9038 07
January 1, 2020 CPT codes 93985, 93986 09
January 1, 2020 CPT codes 66987, 66988, 99201, 92202, 92273, 92274 HCPCS codes C9034, G2102 thru G2104, J0179, J1096, J1097, J2797 10

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.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Audiology and Hearing Aids
Chronic Dialysis Clinics
Clinics and Hospitals
Durable Medical Equipment
General Medicine
Home Health Agencies/Home and Community-Based Services
Inpatient Services
Local Educational Agency
Medical Transportation
Obstetrics
Orthotics and Prosthetics
Pharmacy
Psychological Services
Rehabilitation Clinics
Therapies
Vision Care
cal child ser (1, 2, 4, 8–17, 21–25, 28, 31, 33, 36–38, 46–49, 52)
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6. July 2020 NCCI Updates with Announced Correction

The Centers for Medicare and Medicaid Services (CMS) updated payment policy as part of the National Correct Coding Initiative (NCCI) Quarterly Updates for July 2020. The mandatory national edits were incorporated into the Medi-Cal claims processing system and were effective for dates of service on or after July 1, 2020.

Upon release, the Medically Unlikely Edit (MUE) values and MUE Adjudication Indicators (MAI) were inaccurate for the following HCPCS codes. CMS issued replacement MUE Quarter 3 2020 files for Practitioners (PRA) and Outpatient providers (OPH) retroactive to July 1, 2020.

Providers may refer to The National Correct Coding Initiative in Medicaid page of the Medicaid website for information.

No action is required of providers. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims.

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7. Administrative Hearings to be Conducted by Telephone or Video Conference

The Office of Administrative Hearings and Appeals (OAHA) will conduct informal reviews, pre-hearing matters, settlement conferences, formal hearings and other matters via telephone or video conference, while Executive Orders N-55-20 and N-63-20 are in effect. The Department of Health Care Services (DHCS) recently issued guidance on timeframe extensions and data submittal deadlines for audits, and updates to administrative hearing timelines and processes, available on the DHCS website. For questions regarding this guidance, please email the OAHA inbox at OAHAmailbox@dhcs.ca.gov.

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8. Medi-Cal Rx Portal Registration Launched for Pharmacy Providers and Prescribers

The Department of Health Care Services (DHCS) continues to make significant towards a successful transition of pharmacy services on January 1, 2021 to Medi-Cal Rx.

To help facilitate a smooth and effective transition for Medi-Cal providers, beneficiaries, and other interested parties, DHCS has taken proactive steps to deploy a robust and multi-faceted outreach campaign, which includes, developing comprehensive beneficiary notices, developing call center scripts, conducting targeted provider outreach and providing for and advertising publicly various training opportunities available starting in October and continuing through the end of the year.

Additional activities include developing a dedicated Medi-Cal Rx website with secure portal components for Medi-Cal providers, health plans, beneficiaries and other interested parties.

Recently, DHCS launched the dedicated Medi-Cal Rx secure web portal, https://medi-calrx.dhcs.ca.gov/home/, and a registration page for Medi-Cal provider access, including but not limited to physician prescribers and pharmacies. This registration is the first step in the process for pharmacies and prescribers to use the Medi-Cal Rx secure web portal andits web-based tools for pharmacy services. For detailed registration and training instructions, access the Medi-Cal Rx Web Portal and Training Registration article located on the Pharmacy News Page (https://medi-calrx.dhcs.ca.gov/provider/pharmacy-news).

Access to the Medi-Cal Rx secure web portal will include key functions such as:

Other functions within the Web Portal include:

DHCS reminds Medi-Cal providers, health plans, beneficiaries and other interested parties that it is very important registration be completed early so user training and access are complete and active by January 1, 2021. Doing so will help to remove any potential challenges for successful utilization of the Medi-Cal Rx secure web portal.

The entire dedicated Medi-Cal Rx website will be fully operational by January 1, 2021. In the meantime, DHCS encourages Medi-Cal pharmacy providers and prescribers, health plans, beneficiaries, and other interested parties to sign up for the Medi-Cal Rx Subscription Service, which allows interested parties to receive Medi-Cal Rx updates in near real-time by email.

For general project questions and/or comments, please visit the DHCS website or email RxCarveOut@dhcs.ca.gov. In addition, DHCS encourages stakeholders to review the Medi-Cal Rx Frequently Asked Questions (FAQ) document, which continues to be updated as the project advances.

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9. National Correct Coding Initiative Quarterly Update for October 2020

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 October 1, 2020.

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

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10. 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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