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Medi-Cal Update

Psychological Services | December 2021 | Bulletin 555

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1. 2022 HCPCS Annual Update

The 2022 Annual updates to the Healthcare Common Procedure Coding System (HCPCS) codes are available in the HCPCS Policy Updates PDF. Only those codes representing current and past Medi-Cal and Family Planning, Access, Care and Treatment (FPACT) benefits are included in the list of updates.

The code additions, changes and deletions are effective for dates of service on or after January 1, 2022. Please refer to the HCPCS Level I and II code books for complete descriptions of these codes.

Provider Manual(s) Page(s) Updated
AIDS Waiver Program modif app (10, 11)
Audiology and Hearing Aids
Home Health Agencies/Home and Community-Based Services
Local Educational Agency
Medical Transportation
Orthotics and Prosthetics
cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11)
Chronic Dialysis Clinics cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); path bil (6); path chem (7)
Clinics and Hospitals
General Medicine
anest (5, 7); cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); cardio (5, 14, 15, 22, 24); chemo drug a-d (3, 7, 35, 36, 43); chemo drug e-o (13–15, 23–25); chemo drug p-z (4–7); ev woman (32); eval (10, 25, 26, 33, 34, 37, 38, 39, 44); fam planning (12); hyst (4); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); medne (10); medne neu (8); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); once (1, 9); path bil (6); path chem (7); path immun (2); path micro (3); path molec (57, 91); presum bill (6, 12); prop lab (41, 62, 63); radi dia (7, 8, 29–31); radi nuc (7); respir (7, 9); surg eye (2, 5, 7); surg muscu (7); surg nerv (11); surg integ (4); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Durable Medical Equipment
Therapies
cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11); respir (7, 9)
Family PACT ben fam (19); office (3)
Inpatient Services cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); hyst (4); medne (10); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Obstetrics anest (5, 7); cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); ev woman (32); eval (10, 25, 26, 33, 34, 37, 38, 39, 44); fam planning (12); hyst (4); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); once (1, 9); path bil (6); path chem (7); path immun (2); path micro (3); path molec (57, 91); presum bill (6, 12); prop lab (41, 62, 63); radi dia (7, 8, 29–31); radi nuc (7); tar and non cd0 (13, 21, 26, 38–41); tar and non cd2 (6); tar and non cd4 (9, 14); tar and non cd5 (14, 18); tar and non cd6 (3, 11, 12, 19, 31); tar and non cd7 (7); tar and non cd8 (1, 4, 12); tar and non cd9 (3, 4, 10, 13, 27, 28, 36, 37)
Pharmacy cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); presum bill (6, 12)
Psychological Services cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58)
Rehabilitation Clinics cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); inject cd list (2, 3, 6, 7, 13, 16, 20, 21); inject drug a-d (3–5, 12, 13, 19, 20); inject drug n-r (28); modif app (10, 11); modif used (4, 7, 10–12, 14–16); non inject (22, 23); non ph (9, 10, 13, 14, 15); respir (7, 9)
Vision Care cal child ser (1, 3, 8, 12, 13, 32, 34, 36, 58); modif app (10, 11); modif used vc (3); rates max optom (3)

2. Safety Net Clinic Billing Instructions for CalAIM Dental Initiatives

Effective for dates of service on or after January 1, 2022, the Department of Health Care Services (DHCS) will implement the California Advancing and Innovating Medi-Cal (CalAIM) dental initiatives statewide. CalAIM dental initiatives are based on the successful outcomes of the Dental Transformation Initiative (DTI), which was implemented in certain counties from 2016 to 2021 under the 2020 Medi-Cal 1115 Waiver.

CalAIM dental initiatives include pay-for-performance payments for preventive services and continuity of care/establishing a dental home, and two new program benefits: caries-risk assessment (CRA) bundle for children ages zero to six and application of caries arresting medicament silver diamine fluoride (SDF).

For the pay-for-performance payments, Indian Health Services, Memorandum of Agreement (IHS-MOA), Federally Qualified Health Centers (FQHCs), Tribal FQHCs and Rural Health Clinics (RHCs) also referred to as Safety Net Clinics (SNCs), must submit detailed claims data to the Dental Fiscal Intermediary (FI) following the guidelines below for the new CRA and SDF benefits. In addition to the pay-for-performance payments, dental services will be reimbursable at the clinic’s established per-visit rate via the Medi-Cal FI using the billing instructions in the Rural and Indian Health Provider, Tribal FQHC Manuals.

Pay-for-Performance Payments

  • Preventive services, paid at 75% of the standard Schedule of Maximum Allowances (SMA) fee for each paid preventive service

    • The Current Dental Terminology (CDT) procedures eligible for this pay-for-performance payment are as follows:

    • Ages 0 to 20:

      • D1120, prophylaxis, child

      • D1206, topical application of fluoride varnish

      • D1208, topical application of fluoride – excluding varnish

      • D1351, sealant – per tooth

      • D1352, preventive resin restoration in a modern to high caries risk patient, permanent tooth

      • D1510, space maintainer – fixed, unilateral – per quadrant

      • D1516, space maintainer – fixed, bilateral, maxillary

      • D1517, space maintainer – fixed, bilateral, mandibular

      • D1526, space maintainer – removable, maxillary

      • D1527, space maintainer – removable, mandibular

      • D1551, re-cement or re-bond bilateral space maintainer – maxillary

      • D1552, re-cement or re-bond bilateral space maintainer – mandibular

      • D1553, re-cement or re-bond unilateral space maintainer – per quadrant

      • D1556, removal of fixed unilateral space maintainer – per quadrant

      • D1557, removal of fixed bilateral space maintainer – maxillary

      • D1558, removal of fixed bilateral space maintainer – mandibular

      • D1575, distal shoe space maintainer, fixed, unilateral – per quadrant

    • Ages 21 or older:

      • D1320, tobacco counseling for the control and prevention of oral disease

      • D1999, unspecified preventive procedure, by report

  • Continuity of care, paid at $55 annually for each beneficiary who receives at least one annual dental exam for two or more years in a row at the same dental service office location (dental home).

    • The CDT procedures eligible for this pay-for-performance payment are as follows:

      • D0120, periodic oral evaluation – established patient

      • D0145, oral evaluation for a patient under three years of age and counseling with primary caregiver

      • D0150, comprehensive oral evaluation – new or established patient

  • Pay-for-performance payments are issued to providers once per month and inclusive of both preventive services and continuity of care.

  • To earn pay-for-performance payments, SNCs must send qualifying paid claims data (including CDT codes for services rendered) to the Dental FI for processing and payment. Claims must be submitted within 12 months of the date of service to qualify for payment. Claims may be submitted electronically through the Electronic Data Interchange (EDI) process, or the proprietary paper form submission process described on the CalAIM Dental web page. The proprietary mailing address is:
Medi-Cal Dental Operations
SNC Paper Encounter Submissions
PO Box 13189
Sacramento, CA  95813-3189

New Benefits

The new benefits described below are reimbursable at the clinic’s established per-visit rate.

  • CRA and nutritional counseling bundle for children ages zero to six.

    • All providers are required to take and complete the Treating Young Kids Everyday (TYKE) training hosted by the California Dental Association to provide CRA treatment to patients. If a provider has previously completed the TYKE training for DTI, they do not have to retake the training.

    • Certification of completion must remain on file for audit purposes.

    • Providers must use the CRA forms, which are posted on the DHCS CalAIM Dental These forms must remain on file for audit purposes.

  • SDF application for children ages zero to six and for individuals of all ages for whom non-restorative caries treatment is optimal (including the Department of Developmental Services [DDS] population, those living in Skilled Nursing Facilities/Intermediate Care Facilities [SNFs/ICFs], or those with another demonstrated medical necessity).

Providers are reminded that treatment plans should be patient-centered and equitable. Per Medi-Cal Dental policy, providers shall minimize the number of dental visits for the patient when applicable, feasible, and consistent with the standard of care. Documentation should follow requirements established in the Medi-Cal Dental Provider Handbook and Manual of Criteria and should indicate the medical necessity of any additional visits required for treatment. In most cases, SDF/caries arresting medicaments should be applied during the regular dental exam, prophylaxis appointments, or during CRA appointments.

3. Non-Specialty Mental Health Services are Updated

Effective for dates of service on or after January 1, 2022, Non-Specialty Mental Health Services (NSMHS) are updated via managed care and fee-for-service delivery systems. NSMHS include the following:

  • Mental health evaluation and treatment, including individual, group and family psychotherapy

  • Psychological and neuropsychological testing, when clinically indicated to evaluate a mental health condition.

  • Outpatient services for purposes of monitoring drug therapy

  • Psychiatric consultation

  • Outpatient laboratory, drugs, supplies and supplements

A managed care plan is required to provide these NSMHS to the following recipients:

  • Recipients 21 years of age and older with mild to moderate distress or mild to moderate impairment of mental, emotional, or behavioral functioning resulting from mental health disorders, as defined by the current Diagnostic and Statistical Manual of Mental Disorders

  • Recipients under 21 years of age, to the extent otherwise eligible for services through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), regardless of level of distress or impairment, or the presence of a diagnosis, and

  • Recipients of any age with potential mental health disorders not yet diagnosed

Detailed information regarding Specialty Mental Health Services (SMHS) and NSMHS may be found in the Non-Specialty Mental Health Services: Psychiatric and Psychological Services section of the provider manual and includes information on the following:

  • Coverage of NSMHS and SMHS delivered prior to a diagnosis during the assessment period

  • Coverage of NSMHS and SMHS delivered to recipients with a co-occurring mental health condition and substance use disorder

  • Coverage of NSMHS and SMHS when delivered concurrently

  • Coverage of mental health services for recipients who meet both NSMHS and SMHS criteria

The Psychiatry and Psychological Services sections of the provider manual have been merged and renamed Non-Specialty Mental Health Services: Psychiatric and Psychological Services.

Updates to NSMHS include the following:

  • Clarification that recipients may self-refer for any form of psychotherapy delivered in an outpatient setting.

  • Treatment Authorization Requests (TARs) are no longer required for psychotherapy in nursing facilities.

  • Medical necessity criteria for psychotherapy are updated.

  • Documentation requirements for psychiatric diagnostic evaluation are specified.

  • The frequency limit for brief emotional/behavioral assessment (CPT® code 96127) is updated to two per day, per provider.

  • Medical necessity criteria are specified for the following services:

    • Aphasia assessment (CPT code 96105)

    • Developmental testing (CPT codes 96112 and 96113)

    • Neurobehavioral examination (CPT codes 96116 and 96121)

    • Psychological testing (CPT codes 96130, 96131, 96136 thru 96146)

    • Cognitive rehabilitation (CPT codes 97129 and 97130)

    • Interactive complexity (CPT code 90785)

    • Psychiatric diagnostic evaluation (CPT codes 90791 and 90792)

  • The practitioner types for whom specific NSMHS are reimbursable have been updated.

  • The allowable places of service for some NSMHS have been updated.

For more information regarding these updates, refer to the Non-Specialty Mental Health Services: Psychiatric and Psychological Services section of the provider manual.

For information about updated rates for NSMHS, refer to Non-Specialty Mental Health Services: Reimbursement Rates and Billing Codes and the Medi-Cal Rates page.

Medical team conference CPT codes 99366 and 99368 are reimbursable to licensed clinical social workers, licensed marriage and family therapists, licensed professional clinical counselors, psychologists, occupational therapists, physical therapists and social workers. CPT codes 99366 and 99368 are limited to conferences with persons immediately involved in the case or recovery of the client. The frequency limit for 99366 and 99368 is one per day, per provider. For more information, refer to the Evaluation and Management (E&M) section of the appropriate Part 2 provider manual.

Postpartum depression screenings billed using the child’s Medi-Cal ID require HIPAA-compliant documentation in the child’s medical record of the screening results and any recommendations/referrals that were given. For more information, refer to the Evaluation and Management (E&M) section of the appropriate Part 2 provider manual.

Provider Manual(s) Page(s) Updated
Audiology
Durable Medical Equipment
Long Term Care
Orthotics and Prosthetics
Therapies
tar crit nf (1–4, 7, 8)
Chronic Dialysis Clinics modif used (3, 6, 12, 15)
Clinics and Hospitals
General Medicine
eval (2, 5, 7, 9–11, 28, 33, 41, 42); modif used (3, 5, 12, 15); non ph (9); non spec mental (1–30); preg early (2); preg post (4)
Obstetrics eval (2, 5, 7, 9–11, 28, 33, 41, 42); modif used (3, 5, 12, 15); non ph (9); preg early (2); preg post (4)
Home Health Agencies/Home and Community-Based Services preg post (4)
Inpatient Services preg post (4); tar crit nf (1–4, 7, 8)
Psychological Services non spec mental (1–30); non spec mental cd (1–6); tar crit nf (1–4, 7, 8)
Rehabilitation Clinics modif used (3, 5, 10, 13); non ph (9); tar crit nf (1–4, 7, 8)

4. COVID-19 Global Outreach Language

On September 20, 2021, the Department of Health Care Services released a Medi-Cal Eligibility Division Information Letter (MEDIL) to provide counties, health plans, Medi-Cal providers, and other stakeholders with COVID-19 related global outreach language. The purpose of the global outreach language is to provide our partners with a tool to utilize in order to help encourage Medi-Cal beneficiaries to contact the county and report household changes and provide updated contact information. Maintaining accurate contact information allows beneficiaries to receive important information about their Medi-Cal coverage during and after the COVID-19 Public Health Emergency.

The global outreach language includes messaging that can be used for any of the following type of outreach:

  • Social Media

  • Call scripts

  • Flyers

  • Inserts

  • Websites

A link to the MEDIL can be found here: https://www.dhcs.ca.gov/services/medi-cal/eligibility/letters/Documents/I21-21.pdf. Providers are highly encouraged to participate in the outreach effort and utilize the global outreach language to maintain a consistent message to Medi-Cal beneficiaries about updating their contact information.

5. National Correct Coding Initiative Quarterly Update for December 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 claims received on or after January 1, 2022.

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

6. February 2022 Medi-Cal Provider Training Webinars

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

Categories offered will include the following:

  • Eligibility: February 1, 2022.

  • Claims: February 3, 2022, and February 8, 2022.

  • Resources: February 8, 2022, and February 22, 2022.

  • Medical Services: February 17, 2022.

  • Special Claims Billing: February 10, 2022, and February 15, 2022.

  • Home Health Services: February 17, 2022.

  • Specialty Programs: February 15, 2022, and February 24, 2022.

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.

7. 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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