Implementation Update: Cinacalet Tablets Now a Medi-Cal Benefit

December 28, 2020

An article published in the November 2020 Medi-Cal Update titled “Cinacalcet Tablets Now a Medi-Cal Benefit” announced that for dates of service on or after September 1, 2019, HCPCS code J0604 (cinacalcet, oral, 1 mg, [for ESRD on dialysis]) is a Medi-Cal benefit.

A follow-up News article on December 3, 2020, titled “Implementation Delay for Submitting Claims for Cinacalcet Tablets” announced that the updates necessary to implement the policy were delayed.

This article is to announce that the changes to make HCPCS code J0604 a Medi-Cal benefit are implemented and the code is now billable. The policy and guidance previously shared in the Medi-Cal Update are still in effect. For convenience, the information is duplicated below:

Effective retroactively for dates of service on or after September 1, 2019, HCPCS code J0604 (cinacalcet, oral, 1 mg, [for ESRD on dialysis]) is a Medi-Cal benefit.

An approved Treatment Authorization Request (TAR) is required for reimbursement.

Providers will need to rebill denied claims for medications that were dispensed to beneficiaries from September 1, 2019, to December 28, 2020. The timeliness requirement for the rebilling of denied claims will be waived. End Stage Renal Disease (ESRD) facilities must submit claims with AX modifier for reimbursement using the Traditional Drug Add-On Payment Adjustment.