EPSDT Home Health Services Code Conversion Reminder

October 30, 2018

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) home health services code conversion will replace non-HIPAA-compliant HCPCS Level III codes, commonly referred to as local codes, with HIPAA-compliant CPT Category I and HCPCS Level II national codes. HIPAA mandated these changes to billing requirements for EPSDT home health services.

For claims with dates of service on or after January 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

Providers should prepare and submit Treatment Authorization Requests (TARs)/electronic TARs (eTARs) or Service Authorization Requests (SARs)/electronic SARs (eSARs) according to the instructions provided on the HIPAA: Code Conversions page.

Providers are encouraged to watch for EPSDT home health service updates in the NewsFlash area of the Medi-Cal website and in the monthly Medi-Cal Update. Providers may complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to EPSDT home health services.

For additional information, providers may:

  • Visit the EPSDT Services: Home Health section on the HIPAA: Code Conversions page.
  • Request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers call (916) 636-1200. Providers calling from outside of California call the Out-of-State Provider Unit at (916) 636‑1960.
  • For electronic claim submission questions, contact the TSC at 1-800-541-5555 and select option “4” for the Technical Help Desk and option “2” for CMC.

All other questions regarding the EPSDT home health services code conversion may be submitted via email to CAMMISCodeConversion@conduent.com.