Medi-Cal Logo

Medi-Cal Update

Therapies | August 2021 | Bulletin 551

Print Medi-Cal Update Print Icon

1. New DME Rental Benefit: Phototherapy Light for Infants

Effective for dates of service on or after September 1, 2021, HCPCS code E0202 (phototherapy [bilirubin] light with photometer) is a Medi-Cal benefit for infants as a daily rental only. Because the light is rented, modifier RR is required. For reimbursement, documentation must indicate that the recipient meets the following criteria:

  • The infant’s total serum bilirubin is in the “optional range” as defined by the American Academy of Pediatrics Subcommittee on Hyperbilirubinemia; and

  • The infant is feeding, voiding and stooling well and appears well; and

  • Close follow-up evaluation can be accomplished

Claims submitted to bill for the phototherapy light may be submitted under the mother’s Medi-Cal ID if the infant’s Medi-Cal eligibility has not yet been established. Claims that use the mother’s Medi-Cal ID for the infant, must indicate in the Patient Relationship to Insured field (Box 6) that the “patient is the child of the insured.”

The frequency limit for HCPCS code E0202 is 10 days per lifetime, per infant. A Treatment Authorization Request (TAR) can override the frequency limit when more than one infant born to the same mother (for example, twins, or infant from subsequent birth) requires phototherapy. When phototherapy is needed for more than one infant, claims for phototherapy require a statement in the Additional Claim Information field (Box 19) specifying the number of infants needing phototherapy at this time or that a previous claim was submitted for a sibling who also required phototherapy.

Provider Manual(s) Page(s) Updated
Durable Medical Equipment
dura cd (9); dura cd fre (2); dura other (2, 15, 16)
Orthotics and Prosthetics
dura cd (9); dura cd fre (2)

2. 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.

3. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:

Download PDF (Portable Document Format) reader from the Web Tool Box.