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Medi-Cal Update

Medical Transportation | March 2021 | Bulletin 546

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1. Updated CCS COVID-19 Guidance, CCS FAQs and COVID Vaccine Flexibilities

The Department of Health Care Services (DHCS) recently developed and posted the following documents to the COVID-19 Information for Providers & Partners web page to provide Coronavirus disease (COVID-19) related guidance for the California Children’s Services (CCS) Program:

  1. Updated CCS COVID-19 Guidance

  2. CCS FAQs for COVID-19 Flexibilities

  3. Flexibilities for County Staff during COVID Vaccine Administration

These documents are also available on the CCS Letters web page.

2. Rates for Certain COVID-19 Diagnostic Testing HCPCS Codes Updated

Effective for dates of service on or after January 1, 2021, the base payment amount for HCPCS Codes U0003 (Infectious agent detection by nucleic acid [DNA or RNA]; Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)], amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R), and U0004 (2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV [COVID-19], any technique, multiple types or subtypes [includes all targets], non-CDC, making use of high throughput technologies as described by CMS-2020-01-R), has been adjusted from $100 to $75.

HCPCS Code Description Current Rate New Rate
U0003 SARS Cov-2 COVID-19 Amp prob high throughput $100.00 $75.00
U0004 COVID-19 lab test non-CDC high throughput $100.00 $75.00

Additionally, the codes listed above will be exempt from the 10 percent payment reductions in Welfare and Institutions Code (W&I Code) section 14105.192, as described at Attachment 4.19-B, page 3.3, paragraph 13 of the State Plan.

An Erroneous Payment Correction (EPC) will be issued for affected claims for codes U0003 and U0004 retroactive to dates of service on or after January 1, 2021.

3. New ICD-10-CM and ICD-10 PCS Diagnosis Codes Related to COVID-19

Effective for dates of service on or after January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has added new ICD-10-CM codes and ICD-10 PCS codes for diagnoses related to coronavirus disease 2019 (COVID-19). Information and downloads for these codes can be found on the ICD-10 page of the CMS website. Specific billing policy related to this update will be published in a future Medi-Cal Update and Family PACT Update.

4. CCS Program and GHPP Require Separate SAR for Risdiplam

Effective retroactively for dates of service on or after August 1, 2020, the California Children’s Services (CCS) program and the Genetically Handicapped Persons Program (GHPP) require a separate Service Authorization Request (SAR) for risdiplam. This drug is not included in a physician service code grouping (SCG).

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 sar (8, 9); genetic (10, 11)

5. Single-Use Drug/Biological Wastage Now Reimbursable with JW Modifier

Effective for dates of service on or after April 1, 2021, the HCPCS Level II, JW modifier may be used on drug claims to report the amount of drug or biological that is discarded and eligible for payment under the discarded drug policy.

The discarded drug amount is the amount of a single-use vial or other single-use package that remains after administering a dose/quantity of the drug to a Medi-Cal beneficiary. This policy applies to all separately billable drugs that are designated as single-use or single-dose on the FDA-approved label or package insert. Package size can be verified on the FDA website at http://www.accessdata.fda.gov/scripts/cder/drugsatfda/.

JW modifier should not be used for the following:

  • Drugs that are not separately payable, such as packaged Outpatient Prospective Payment System (OPPS) drugs or drugs administered in the Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) setting since they are not generally separately billable

  • Drugs paid under the Part B drug Competitive Acquisition Program (CAP) (the CAP remains on hold and there is currently no list of CAP medications)

  • Claims for hospital inpatient admissions that are billed under the Inpatient Prospective Payment System (IPPS)

  • When the actual dose administered is less than the HCPCS billing unit, since payment will not be made using fractional billing units and billing the discarded amount in addition to the HCPCS unit may result in overpayment

Instructions for billing and documentation:

  • Providers are to bill drug/biological wastage using the JW modifier in addition to documenting the name, dosage, route of administration and National Drug Code (NDC) of the drug/biological on the claim form

  • Providers are to document the discarded drug/biological in the Medi-Cal beneficiary’s medical records, including the date, time and quantity wasted

  • Providers are to bill the discarded drug/biological on a separate claim line with the JW modifier
Provider Manual(s) Page(s) Updated
AIDS Waiver Program
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
modif (2–4); modif app (14)
Audiology and Hearing Aids
Durable Medical Equipment
Home Health Agencies/Home and Community-Based Services
Local Education Agency
Medical Transportation
Orthotics and Prosthetics
Therapies
Vision Care
modif app (14)

6. National Correct Coding Initiative Quarterly Update for April 2021

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 April 1, 2021.

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

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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.

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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.

8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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