Medi-Cal Logo

Medi-Cal Update

Vision Care | December 2021 | Bulletin 527

Print Medi-Cal Update Print Icon

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. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. Provider Manual Revisions

Pages updated due to ongoing provider manual revisions:



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