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Medi-Cal Update

Therapies | August 2021 | Bulletin 551

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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
Pharmacy
dura cd (9); dura cd fre (2); dura other (2, 15, 16)
Orthotics and Prosthetics
Therapies
dura cd (9); dura cd fre (2)

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3. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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