EPSDT Home Health Code Conversion: Technical Publications and Support

September 7, 2018

Effective for dates of service on or after January 1, 2019, the Department of Health Care Services (DHCS) will discontinue HCPCS Level III local codes for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Home Health. These codes will be replaced by HIPAA-compliant CPT Category I and HCPCS Level II national codes, utilized by Medicare, to comply with provisions of the 1996 Public Law 104-191, 45 CFR 162.1000.

Providers who bill for EPSDT Home Health services using the American National Standards Institute (ANSI) 837P and 837I transactions for electronic billing are encouraged to visit the Testing and Activation Procedures section of the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual required by CMC to ensure accurate file format, completeness and validity.

Submitters may test status to ensure accurate file format, completeness and validity for HIPAA-compliant claims transactions by logging into the Medi-Cal test site using their submitter ID and password. Instructions for CMC testing are located in the Testing and Activation Procedures section of the CMC Billing and Technical Manual.

CMC evaluates the test file and determines if the following requirements have been met:

  • All format types
  • Telecommunications equipment is technically compatible with the DHCS Fiscal Intermediary (FI) system
  • The claim data can be read by the claims processing system
  • Records and mandatory fields required for CMC are present and contain valid information (for example, provider number[s], submitter number, control records, claim records)

A new test must be submitted when software is upgraded or the submission method changes.

The CMC Help Desk can be accessed by calling the Telephone Service Center (TSC) at 1-800-541-5555 and selecting the option “Point of Service (POS), Internet, Laboratory Services Reservation System (LSRS) and CMC inquiries.

For additional information, providers may: Providers who would like to receive monthly email notification for newly published Medi-Cal Update bulletins should complete the Medi-Cal Subscription Service (MCSS) Form.