April 5, 2016
The following article was initially published in the March 2016 Medi-Cal Update. This update includes a revised Medical Transportation Code Conversion Table, accessible from the link below.
Effective for dates of service on or after July 1, 2016, Treatment Authorization Requests (TARs), Service Authorization Requests (SARs) and claims billed with HCPCS Level III local medical transportation codes and HCPCS Level III local modifier Z1 will no longer be eligible for reimbursement.
The medical transportation code conversion, announced in the March 2015 Medi-Cal Update, had an initial effective date of April 1, 2015; however, a transition period was established to allow providers time to begin billing with the HCPCS Level II national HIPAA-compliant codes. This transition period will expire on June 30, 2016.
Providers submitting TARs, electronic TARs (eTARs) and SARs with dates of service on or after July 1, 2016, must include only HCPCS Level II national HIPAA-compliant codes as described in the updated Medical Transportation Code Conversion Table.
Providers should review their inventory for previously-approved TARs and SARs with medical transportation services that have dates of service on or after July 1, 2016. For those TARs and SARs, providers must submit a new TAR, eTAR or SAR with the appropriate HCPCS code to cover any remaining service period on or after July 1, 2016.
If a TAR or SAR is submitted for the purpose of updating codes in the same authorization period, it will not be reviewed for medical necessity. Providers may bypass the medical authorization process by including the previously approved TAR number in the Medical Justification field (Box 8C) of the TAR or the Enter Miscellaneous TAR Information field (Box 8C) of the eTAR.
Providers should refer to the Medical Transportation section of the HIPAA: Code Conversions Web page for a complete list of Medical Transportation Code Conversion resources, including:
- Frequently Asked Questions (FAQs)
- TAR and SAR policy updates
- Billing policy updates for ambulance, litter van, and wheelchair mileage
- Transition period end-dating and details