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, HCPCS Level III local medical transportation codes and HCPCS Level III local modifier Z1 (additional air mileage in excess of 10 percent of standard airway mileage distances) will be discontinued. These codes will be replaced with HCPCS Level II national HIPAA-compliant codes, utilized by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.
To view the full code conversion, including relevant additional instructions, see the updated Medical Transportation Code Conversion Table.
Providers should prepare and submit Treatment Authorization Requests (TARs) and Service Authorization Requests (SARs) according to the instructions below.
TAR Conversion Policy for Previously Approved, Retroactive and Deferred TARs
All TARs with local codes and/or a combination (HCPCS Level III and Level II procedure codes), regardless of status (approved, retroactive or deferred), will be end-dated for dates of service on or after July 1, 2016. Providers are encouraged to submit new TARs or electronic TARs (eTARs) with the appropriate HCPCS Level II national code(s) prior to July 1, 2016.
Bypassing Medical Authorization for Replacement TARs
When replacing end-dated TARs or eTARs that include a medical authorization prior to July 1, 2016, bypass the medical authorization process. This is done 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.
TARs Submitted After July 1, 2016
All TARs and eTARs submitted on or after July 1, 2016, that require authorization beyond this date must include only HCPCS Level II national codes with applicable modifier(s). Modifiers are entered in the Enter Miscellaneous TAR Information field (Box 8C) of the eTAR and in the Medical Justification field (Box 8C) of the TAR.
Medi-Cal strongly encourages the use of eTARs. Provider benefits when using the eTAR include: no mail delays or postage, savings in time and money and a quicker response time. Additionally, the eTAR allows providers to check the status of their TAR at any time. For additional information, providers should look for an upcoming eTAR seminar in their area, or call the Telephone Service Center at 1-800-541-5555.
SAR Conversion Policy
Effective for dates of service on or after July 1, 2016, new SARs for medical transportation services must include HCPCS Level II national codes.
SARs Submitted After June 30, 2016
California Children’s Services (CCS)/Genetically Handicapped Persons Program (GHPP) providers should review their medical transportation SARs that extend beyond June 30, 2016. For those SARs, providers must submit a new SAR, with the appropriate HCPCS Level II national code(s), to cover any remaining service period after June 30, 2016.
SARs Previously Authorized with Through Dates Beyond June 30, 2016:
Beginning July 1, 2016, SARs authorized with through dates beyond June 30, 2016, must be end-dated. At the same time, providers should request existing SARs with the HCPCS Level III local codes be end-dated effective June 30, 2016.
SARs Submitted After July 1, 2016:
Effective July 1, 2016, providers may begin requesting SARs with HCPCS Level II national codes for dates of service on or after July 1, 2016. SAR requests using the HCPCS Level III local codes may be submitted only for dates of service ending on or before June 30, 2016.
SARs with HCPCS Level III local codes received after June 30, 2016 may be denied. Providers may need to resubmit SARs with the appropriate HCPCS Level II national codes.