Medi-Cal Update

Pharmacy | October 2020 | Bulletin 977

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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. Update to Medi-Cal Rx Support Services and Key Payer Sheet Details

In April 2020, the Department of Health Care Services (DHCS) began publishing a series of articles regarding the upcoming Medi-Cal Rx transition. The transition of all administrative services related to Medi-Cal pharmacy benefits billed on pharmacy claims from the existing intermediaries, Medi-Cal fee-for-service (FFS) or Managed Care Plans (MCPs), to the new Medi-Cal Rx vendor, Magellan Medicaid Administration, Inc. (Magellan), goes into effect January 1, 2021.

This article provides an update on Medi-Cal Rx support services and key payer sheet details so that pharmacy providers and their billing agents can begin incorporating changes into their processes and technical solutions.

Provider Support Services

As outlined below, initial support services will be provided through portal and email inquiry services, as well as published transition forums. As other support services are launched, notifications will be issued to alert the provider community.

Medi-Cal Rx Support Prior to January 1, 2021

For information on Medi-Cal Rx, visit the Provider Portal on www.Medi-CalRx.dhcs.ca.gov or the DHCS Medi-Cal Rx Transition page. For general questions relating to Medi-Cal Rx, please direct your comments and questions to RxCarveOut@dhcs.ca.gov.

Medi-Cal Rx Customer Service Center starting January 1, 2021

Magellan Medicaid Administration (MMA) will implement a Medi-Cal Rx Customer Service Center to assist providers (including but not limited to pharmacists and prescribers) and beneficiaries.

The Medi-Cal Rx Customer Service Center will be available starting January 1, 2021. The toll-free number for the Customer Service Center, 1-800-977-2273, will be available 7 days a week, 24 hours a day and 365 days a year beginning on January 1, 2021. The telephone menu options are included below to allow providers to update processes and any automation that they may have in place.

Nationwide Toll-Free Number: 1-800-977-2273

Main Menu Options:

Medi-Cal Rx customer service representatives will be able to respond to questions that include, but are not limited to the following:

Note:

For beneficiaries dually enrolled in Medicaid and Medicare, beneficiaries should be directed to 1-800-Medicare (1-800-633-4227) or to the help desk of their Medicare Part D prescription drug plan.

Please note that prior to January 1, 2021, for general questions about Medi-Cal Rx, providers should contact the general Medi-Cal Telephone Service Center (TSC) at 1-800-541-5555, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Payer Sheet Details

As key Medi-Cal Rx payer sheet specifics are finalized they are being communicated in advance of formalized documentation so pharmacy providers and their agents can begin making changes. Specifics regarding the beneficiary identification (ID) number, Banking Identification Number (BIN), and Processor Control Numbers (PCNs) for the different pharmacy transactions are referenced below.

Beneficiary ID

The Medi-Cal Program issues a Benefits Identification Card (BIC) to all beneficiaries, both FFS and Managed Care enrollees. For beneficiaries who are enrolled in a Medi-Cal MCP, a plan specific identification card is also issued.

For Medi-Cal Rx, pharmacy providers are expected to utilize the 14-character beneficiary identification number located on the front of the BIC or the 9-character Client Index Number (CIN) which is the same as the first nine characters of the beneficiary identification number. MCP identification cards and associated ID numbers cannot be used for Medi-Cal Rx billing.

Same-day new Medi-Cal enrollments will require the 14-character (BIC) for services rendered on that enrollment day.

Below is a graphic of the current BIC for your reference.

Example of a California BIC card

BINs and PCNs

Medi-Cal Rx will issue a National Council for Prescription Drug Programs (NCPDP) Standard Payer Sheet in a future publication. To enable pharmacy providers and electronic submitters to begin planning for system and/or software updates, Medi-Cal Rx is releasing the BINs and PCNs required for pharmacy claims processing early. These BINs and PCNs will be effective starting January 1, 2021.

National Council for Prescription Drug Programs (NCPDP D.0)

Transaction Type Transaction Code BIN PCN
Claim Billing Request B1 022659 6334225
Claim Billing Reversal Request B2 022659 6334225
Claim Rebill B3 022659 6334225
Eligibility Verification Request E1 022659 6334225
Prior Authorization Reversal P2 022659 6334225
Prior Authorization Inquiry P3 022659 6334225
Prior Authorization Request Only P4 022659 6334225
Drug Pricing Inquiry (SB 393 Price Inquiry) B1 022667 393
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6. Correction to HCPCS Code in DME Manual Section

The Durable Medical Equipment (DME): Bill for DME (dura bil) manual section was previously updated erroneously with “HCPCS code E1300 (DME, miscellaneous)” and the code and description did not match. The correct code and description are E1399 (DME, miscellaneous) and have been corrected on page 8 of the Durable Medical Equipment (DME): Bill for DME provider manual section.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Durable Medical Equipment dura bil (8)
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7. 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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8. Updates to Policy for Injection Codes

Effective for dates of service on or after November 1, 2020, policy has been revised for HCPCS codes J0584 (injection, burosumab-twza, 1 mg) and J3397 (injection, vestronidase alfa-vjbk, 1 mg). The indications, dosage, Treatment Authorization Request (TAR) requirement criteria, age limits, ICD-10-CM diagnosis code requirements and prescribing restrictions have been revised for both codes.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Rehabilitation Clinics
inject drug a-d (28–30); inject drug s-z (21–23)
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9. Updated Policy Effective Date for Billing Immune Globulins

Superseding communication from the Department of Health Care Services (DHCS) in the July 2020 General Bulletin, new changes are introduced for billing and claims submission of various HCPCS Level II and Current Procedural Terminology (CPT®) codes for Physician Administered Drugs (PAD).

As part of ongoing efforts to ensure consistency and accuracy in billing and provider reimbursements, providers must note the following when submitting claims for specific biologicals and drugs.

Preferred Codes for Billing Biologicals With both CPT and HCPCS Codes:

The biologicals below are billed with both CPT and HCPCS codes. The HCPCS codes are often more specific than the CPT codes. Now effective for dates of service on or after October 1, 2019, for reimbursement, providers must submit claims for the listed CPT codes using the corresponding HCPCS codes as shown in the table below:

Procedure Codes Procedure Descriptions Code(s) to Bill with
90281 Immune globulin (Ig), human, for intramuscular use J1460 or J1560
90283 Immune globulin (IgIV), human, for intravenous use J1459, J1556, J1557, J1561, J1566, J1568, J1569, J1572 or J1599
90284 Immune globulin (SCIg), human, for use in subcutaneous infusions, 100 mg, each Bill J1555 (Cuvitru) & J1559 (Hizentra)

Continue to bill 90284 for all other immune globulins used for subcutaneous infusions
90291 Cytomegalovirus immune globulin (CMV-IgIV), human, for intravenous use J0850
90384 Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular J2790 or J2791
90385 Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use J2788
90386 Rho(D) immune globulin (RhIgIV), human, for intravenous use J2791 or J2792
90389 Tetanus immune globulin (TIg), human, for intramuscular use J1670

Providers may continue to bill for Gammagard liquid, Gammaked, Gammunex-C, Cutaquig and Xembify with CPT code 90284.

Cuvitru must be billed with J1555 and Hizentra with J1559.

Processes for Rebilling and Payment Correction of Rho (D) Immune Globulins for Dates of Service On or After October 1, 2019 to August 31, 2020 for Providers Who Billed With CPT Codes and Were Denied or Underpaid:

For providers who previously billed with CPT codes 90384 and 90385 and claims were denied:

For providers who billed with CPT codes 90384 and 90385 and were reimbursed only the injection administration fee of $4.46:

  1. Submit a Claims Inquiry Form (CIF) to void the claim billed with the CPT code.
    • There is no time restriction on this process.

    • When completing the CIF, providers must enter the information exactly as it appears on the Remittance Advice Details (RAD) to ensure the claim is located within the claims processing system.

  2. Rebill using the corresponding J code as indicated in the table above for appropriate reimbursement following the void of the CPT code.

    • These steps ensure that providers are paid at the full Medi-Cal rate available.

    • It is not necessary to submit a TAR.

      • If rebill is submitted beyond the 6-month billing limitation, timeliness of the rebill is waived.

Instructions regarding the submission of CIF can be found here in the Billing Basics Outreach & Education workbook.

Erroneous Payment Correction (EPC) for Dates of Service from August 1, 2020 to August 31, 2020

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10. New Benefits: Magnetoencephalography (MEG) and Magnetic Source Imaging (MSI)

Effective for dates of service on or after November 1, 2020, CPT codes 95965 (magnetoencephalography [MEG], recording and analysis; for spontaneous brain magnetic activity), 95966 (magnetoencephalography [MEG], recording and analysis; for evoked magnetic fields, single modality), and 95967 (magnetoencephalography [MEG], recording and analysis; for evoked magnetic fields, each additional modality) and HCPCS code S8035 (magnetic source imaging) are added as Medi-Cal benefits.

An approved Treatment Authorization Request (TAR) indicating the procedure is for pre-operative brain mapping or epilepsy surgery is required

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics modif used (10)
Clinics and Hospitals
General Medicine
medne neu (11); modif used (10); presum bill (10, 16); radi dia (18–19); tar and non cd9 (18)
Obstetrics modif used (10); presum bill (10, 16); radi dia (18–19); tar and non cd9 (18)
Inpatient Services tar and non cd9 (18)
Pharmacy presum bill (10, 16)
Rehabilitation Services modif used (10)
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11. Corrections on Medi-Cal Benefit for Multi-Function Ventilator

On July 16, 2020, a Medi-Cal Update article was released titled “Multi-function Ventilator a New Medi-Cal Benefit.” This article contained errors that may have caused confusion for some providers when billing for HCPCS codes E0465 (home ventilator, any type, used with invasive interface [e.g. tracheostomy tube]), E0466 (home ventilator, any type, used with noninvasive interface [e.g. mask, chest shell]), or E0467 (home ventilator; multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration and cough stimulation, includes all accessories, components and supplies for all functions). This article attempts to clarify the erroneously published policy.

Corrections are below:

Providers are encouraged to check the Medi-Cal Provider website for future updates.

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12. Policy Update for Sinuva Sinus Implant

Effective for dates of service on or after November 1, 2020, providers should only use HCPCS code C9122 (mometasone furoate sinus implant [Sinuva]),10 mcg) when billing for Sinuva sinus implants. Previously, providers were also able to use HCPCS code J7401 (mometasone furoate sinus implant, 10 mcg). Code J7401 will now only be used to bill for Propel sinus implants.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Chronic Dialysis Clinics
Clinics and Hospitals
General Medicine
Obstetrics
Pharmacy
Rehabilitation Clinics
inject cd list (16); inject drug i-m (33–35)
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13. 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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14. 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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15. Updates to Physician Administered Drugs List

The Physician-Administered Drugs section of the Pharmacy provider manual is updated. A summary of drug that was added is shown below.

Added Drug(s)
Effective Date Drug Summary of Changes Page(s) Updated
October 1, 2020 Levonorgestrel Drug added physician (2)
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16. 2020 Immunization Updates: Vaccination during COVID-19, Flu, HepA, and Tdap

A new DUR Educational Article titled “2020 Immunization Updates: Vaccination during COVID-19, Flu, HepA, and Tdap (PDF format)” is available on the DUR: Educational Articles page of the Medi-Cal website.

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17. 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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18. Notification of Billing Change for Pen Needles

Effective for dates of service on or after January 1, 2021, pen needles will no longer be reimbursable when billed on a CMS-1500 claim form using HCPCS code A4215 (needle, sterile, any size, each), submitted to the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI). Instead, pen needles, when used in conjunction with injection pens to deliver injectable medications, are to be billed on a pharmacy claim form using the contracted product’s National Drug Code.

This change only applies to pen needles. Medical supply benefits and billing policy for conventional, filter and safety sterile needles (excluding pen needles) will still be billed on a CMS-1500 claim form using HCPCS code A4215, product Universal Product Number (UPN), and UPN qualifier, for Medi-Cal fee-for-service beneficiaries.

For beneficiaries in Medi-Cal Managed Care Plans (MCPs), sterile needles (excluding pen needles) are not carved out from managed care to fee-for-service, therefore the beneficiary’s MCP is responsible for providing sterile needles (excluding pen needles) as a benefit.

As a reminder, as of January 1, 2021, Medi-Cal pharmacy claims will be processed by the new Medi-Cal pharmacy vendor.

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Durable Medical Equipment
Pharmacy
mc sup (1, 2, 6)
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19. Average Selling Price Update for Blood Factors

Effective for dates of service on or after October 1, 2020, Esperoct® is billable under HCPCS code J7204 (injection, Factor VIII, antihemophilic factor [recombinant], [Esperoct], glycopegylated-exei, per IU).

This information is reflected in the following provider manual(s):
Provider Manual(s) Page(s) Updated
Clinics and Hospitals
General Medicine
blood (3); non ph (15, 29)
Obstetrics
Rehabilitation Clinics
non ph (15, 29)
Chronic Dialysis Clinics
Pharmacy
blood (3)
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20. 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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21. 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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22. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

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