HIPAA Notice of Code Conversion for EPSDT Home Health

August 3, 2018

Effective for dates of service on or after February 1, 2019, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health code conversion will replace non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT Category I or HCPCS Level II national codes.

For claims with dates of service on or after the policy effective date of February 1, 2019, providers will use a combination of:

  • CPT Category I or HCPCS Level II codes; with a modifier; or
  • Revenue codes and CPT Category I or HCPCS Level II codes with a modifier.
EPSDT services are a Medi-Cal benefit for individuals younger than 21 years of age who have full-scope Medi-Cal eligibility. This benefit allows periodic screenings to determine health care needs. Treatment services are provided based upon the identified health care need and diagnosis. EPSDT services include all services covered by Medi-Cal. In addition to regular Medi-Cal benefits, recipients younger than 21 years of age may receive additional medically necessary services.

Home Health services are reimbursable outpatient benefits, which are prescribed by a physician, and provided at the recipient’s home in accordance with a written treatment plan reviewed by a physician every 60 days. More information regarding home health services can be found in the Home Health Agencies (HHA) section of the appropriate Part 2 Provider Manual.

Crosswalks and Frequently Asked Questions (FAQs) will be available soon. Additional information for this project will be published as details are determined.

Providers are encouraged to routinely checks the Medi-Cal Update provider bulletins or complete the Medi-Cal Subscription Service (MCSS) Form to receive an email notification for newly published Medi-Cal Update bulletins, Newsflash articles, and/or System Status Alerts.