Claims Corner
CenCal HEALTH’s Claims Department posts updates to billing and benefit information for our Providers in our Claims Corner. These articles offer important and timely information that may affect how your claim is adjudicated.
Some of these updates may be changes to CenCal Health processes only, and some may be updates published by the State of California that apply to CenCal Health as well.
We recommend all of our Providers access these articles often. Any questions related to any of these articles may be directed to our Claims Department at (805) 562-1083.
Recent Billing/Policy Update Articles
| Attention | Articles | Posting Date |
| Physicians, Outpatient Hospitals, Clinics and Laboratories | New Benefit: COVID-19 Testing Codes | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Psychiatric Collaborative Care Management | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Skin Substitute | December 2020 |
| DME | Rate Update: Oxygen Systems | December 2020 |
| LTC | Rate Update: Nursing Facility Level A | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: MLH1 Gene Analysis | December 2020 |
| DME | Policy Update: Pen Needles | December 2020 |
| All Providers | Billing Update: 2021 CPT Annual Update | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Abortion CPT Codes | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Ventricular Assist Devices | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Update: National Correct Coding Initiative Quarterly Update | December 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Cinacalcet Tablets | November 2020 |
| Physicians, Outpatient Hospitals, Clinics and Laboratories | Rate Update: Fetal Gene Analysis | November 2020 |
| Physicians, Outpatient Hospitals, Clinics and Laboratories | Rate Update: COVID 19 Reimbursement Rates | November 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: CPT-4 Code 86413 | November 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: FQHC/RHC Annual Rate | November 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: National Correct Coding Initiative | November 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: List of Medical Supplies Billing Codes, Units and Quantity Limits | November 2020 |
| DME | Policy Update: Cough Stimulating Device and Replacement Components | November 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Pen Needles | November 2020 |
| Vision | Update: PIA Optical Laboratory Services Eligibility | November 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 Quantitative Antibody Test | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Magnetoencephalography and Magnetic Source Imaging | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Electroencephalography Procedure | October 2020 |
| LTC | Rate Update: FS/PSA Facilities | October 2020 |
| LTC | Rate Update: DP/PSA Facilities | October 2020 |
| LTC | Rate Update: FS/NF-B Rates | October 2020 |
| LTC | Rate Update: FSSA/NF-B Rates | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CCS and GHPP Service Code Groupings | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Injection Codes | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Sinuva Sinus Implant | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: HCPCS Quarterly Update | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Immune Globulins | October 2020 |
| DME | Correction: DME Manual | October 2020 |
| DME | Correction: Multi-Function Ventilator | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Pharmacies | News: Medi-Cal Rx Portal Registration | October 2020 |
| ALL PROVIDERS | STILL USING PAPER TO SUBMIT CLAIMS? | January 2018 |
Upcoming New Benefits
The following notifications have been identified as upcoming “New Benefits” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “New Benefits” notifications below.
| Attention | Notifications | Posting Date |
| ALL PROVIDERS | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Policy and Rate Changes
The following notifications have been identified as upcoming “Policy and/or Rate Changes” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Policy and/or Rate Changes” notifications below.
| Attention | Notifications | Posting Date |
| ALL PROVIDERS | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Diagnosis Restriction Changes
The following notifications have been identified as upcoming changes related to “Diagnosis Restrictions” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Diagnosis Restrictions” notifications below.
| Attention | Notificationst | Posting Date |
| ALL PROVIDERS | CenCal Health is not currently aware of any upcoming New Benefits at this time. Please check back frequently for future updates. | May 2019 |
Upcoming Code Conversions
The following notifications have been identified as upcoming HIPAA-compliant “Code Conversions” CenCal Health recently became aware of and plans to adopt. These notices are informative only and will not be implemented until an effective date of service has been established; therefore, provider billing changes are not required at this time.
To ensure proper billing and avoid unnecessary denials, please be sure to check the “Recent Billing/Policy Updates” section monthly for articles posting the effective date and specific billing/policy details related to the “Code Conversion” notifications below.
| Attention | Notifications | Posting Date |
| Attention Notifications Posting Date LTC Providers |
COMING SOON — Effective for dates of service TBD — LTC local codes (01-98) will be terminated. Providers should bill using the appropriate HIPAA-compliant Revenue Codes. Please refer to the HIPAA section of our website for the latest conversion details. | July 2018 |
| Outpatient Hospitals | COMING SOON — Effective for dates of service TBD — local codes for Hospital Outpatient Services (Z7500-Z7514, Z7610-Z7614) will be terminated. Providers should bill using the appropriate HIPAA compliant, nationally recognized revenue codes, CPT-4 codes and/or HCPCS codes that best represents the service provided. Please refer to the HIPAA section of our website for the latest conversion information. | July 2018 |
| ALL PROVIDERS | Effective for dates of service on or after July 1, 2017 — CenCal Health will terminate ALL the local codes (X-codes & Z-codes). Providers should bill using the appropriate national CPT-4/HCPCS code, including the appropriate Revenue Code where applicable, that best represents the service provided. Please refer to the HIPAA section of our website for the latest conversion details. | June 2017 |
ARCHIVE - 2020 Recent Billing/Policy Update Articles
Here you will find previously posted 2020 articles from the “Recent Billing/Policy Updates” section
| Attention |
Articles |
Posting Date |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 Quantitative Antibody Test | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Magnetoencephalography and Magnetic Source Imaging | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Electroencephalography Procedure | October 2020 |
| LTC | Rate Update: FS/PSA Facilities | October 2020 |
| LTC | Rate Update: DP/PSA Facilities | October 2020 |
| LTC | Rate Update: FS/NF-B Rates | October 2020 |
| LTC | Rate Update: FSSA/NF-B Rates | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CCS and GHPP Service Code Groupings | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Injection Codes | October 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Sinuva Sinus Implant | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: HCPCS Quarterly Update | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Immune Globulins | October 2020 |
| DME | Correction: DME Manual | October 2020 |
| DME | Correction: Multi-Function Ventilator | October 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Pharmacies | News: Medi-Cal Rx Portal Registration | October 2020 |
| ALL PROVIDERS | STILL USING PAPER TO SUBMIT CLAIMS? | January 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Genomic Sequence Analysis | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: CPT-4 Codes 86408 and 86409 | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Brachytherapy Codes | September 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Rate Update: Clinical Laboratory Rates | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Pharmacy Fee-For-Service | September 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: CPT Code for COVID19 Testing | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Depression Screenings | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CPT Code 81404 | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Remdesivir to Treat COVID19 | September 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Update: Correction for Echocardiography in Provider Manual | September 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 Testing | August 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Provisional Postpartum Care | August 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Family Therapy | August 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CCS Service Code Groupings | August 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: HCPCS Quarterly Update | August 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Update: Abortion Services Due To COVID-19 | August 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: PIK3CA Gene Analysis | July 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Online Assessment and Management Services | July 2020 |
| DME | New Benefit: Multi-function Ventilator | July 2020 |
| DME | Policy Update: Respiratory Suction Pumps | July 2020 |
| DME | Policy Update: High Frequency Chest Wall Oscillation Devices | July 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Eculizumab | July 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: School District Provider Reimbursable Vaccines | July 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Immune Globulins and Adalimumab Injection | July 2020 |
| Medical Transportation | Billing Update: Specialty Care Transport for Non-Emergency Patient Transfers | July 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 Specimen Collection | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Outpatient Treatment of Opioid Use Disorder | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Triamcinolone Acetonide | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Andexanet Alfa (Andexxa) | June 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Rate Update: COVID-19 Specimen Collection | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Split-Billed Radiology | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Depression Screening | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Supplemental Payments for Family Planning Services | June 2020 |
| Physicians, Outpatient Hospitals, Clinics, and DME | Policy Update: Incontinence Creams and Washes | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Immunization Codes | June 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Cystic Fibrosis | June 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: COVID-19 Diagnostic Testing | June 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Modifier CS | June 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 | May 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: 2020 HCPCS Quarterly Update | May 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Meningococcal Conjugate Vaccine | May 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Developmental Screening Policy | May 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Automatic External Defibrillator | May 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Hepatitis C Screening | May 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Koate DVI | May 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: NCCI Quarterly Update | May 2020 |
| DME | Policy Update: Non-Wheelchair Accessories and Supplies | May 2020 |
| DME | Policy Update: Back-up Ventilators | May 2020 |
| DME | Policy Update: Oxygen Modifier | May 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: COVID-19 Anti-body Testing | May 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: COVID-19 Diagnosis | May 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Presumptive Eligibility for COVID-19 Testing | April 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: COVID-19 Lab Tests | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Oncology Codes | April 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Genomic Sequence Analysis | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CCS and GHPP Drug/Nutritional Product Exceptions | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CCS Service Code Groupings | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Fetal Aneuploidy Codes | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Evaluation and Management (E&M) | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Acyclovir | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: NCCI Quarterly Update | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Ophthalmoscopy | April 2020 |
| DME | Billing Update: Incontinence Medical Supplies | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Update: CPT-4 2020 Pathology Codes | April 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Reminder: Dental Services | April 2020 |
| All Providers | New Benefit: Childhood Developmental Screening | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Screening for Adverse Childhood Experiences | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Split-Billed Radiology Services | March 2020 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Rate Update: Fetal Aneuploidy | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Molecular Pathology Procedures | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Place of Service Code 25 | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Contraceptive Ring and Patch | March 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: List of Contracted Sterile Needles | March 2020 |
| DME | Policy Update: Contracted Incontinence Absorbent Products | March 2020 |
| DME | Policy Update: List of Enteral Nutrition Procedures | March 2020 |
| DME | Policy Update: HCPCS Codes A4335 and A6250 | March 2020 |
| All Providers | Update: List of Contracted Drugs | March 2020 |
| All Providers | Correction: 2020 HCPCS Policy Updates | February 2020 |
| Physicians, Outpatient Hospitals, Pharmacies, and Clinics | New Benefit: Durolane | February 2020 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Biovance | February 2020 |
| Long Term Care | Rate Update: Intermediate Care Facility Rates | February 2020 |
| Physicians, Outpatient Hospitals, Pharmacies, and Clinics | Policy Update: Initial Antepartum Office Visits | February 2020 |
| DME and Pharmacies | Policy Update: Incontinence Creams and Washes | February 2020 |
| DME and Pharmacies | Policy Update: Wound Care Advanced Dressings | February 2020 |
| DME | Billing Update: Medical Supply Billing Codes | February 2020 |
| Physicians, Outpatient Hospitals, Long Term Care, and Clinics | New Benefit: Evaluation and Management | January 2020 |
| Physicians, Outpatient Hospitals, Long Term Care, and Clinics | New Benefit: CYP2C19 Gene Analysis | January 2020 |
| Physicians, Outpatient Hospitals, Long Term Care, and Clinics | New Benefit: Ambulatory Blood Pressure Monitoring | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: List of Contracted Incontinence Medical Supplies | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Naltrexone and Buprenorphine Injections | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Ophthalmological Services | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: SMN1 Gene Analysis | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Genetic Testing of Tuberous Sclerosis Complex | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: List of Contracted Waterproof Sheeting | January 2020 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Incontinence Creams and Washes | January 2020 |
| DME | Policy Update: Wheelchair Accessories | January 2020 |
| All Providers | Billing Update: 2020 HCPCS Annual Update | January 2020 |
| All Providers | Update: Provider Manual Updates | January 2020 |
| ALL PROVIDERS | STILL USING PAPER TO SUBMIT CLAIMS? | January 2018 |
ARCHIVE - 2019 Recent Billing/Policy Update Articles
Here you will find previously posted 2019 articles from the “Recent Billing/Policy Updates” section
| Attention | ARCHIVED 2019 Recent Billing/Policy Update Articles | Original Posting Date |
| All Providers | Update: Time-Limited Supplemental Payment for Family Planning Services | December 2019 |
| All Providers | New Benefit: Optician Services Restored | December 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Screening for Adverse Childhood Experiences | December 2019 |
| All Providers | Policy Update: HCPCS Quarterly Update | December 2019 |
| All Providers | Policy Update: National Correct Coding Initiative Quarterly Update | December 2019 |
| All Providers | Policy Update: Childhood Development Screening | December 2019 |
| Physicians, Outpatient Hospitals, Long Term Care, Clinics and DME | Policy Update: Incontinence Creams and Washes | December 2019 |
| Physicians, Outpatient Hospitals, Clinics and DME | Policy Update: Pediatric Incontinence Products | December 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Fulvestrant Injection | December 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Contracted Waterproof Sheeting | December 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Contracted Diabetic Test Strips and Lancets | December 2019 |
| Physicians, Outpatient Hospitals, Inpatient, and Clinics | Policy Update: ICD-10 Procedure Code Policy | December 2019 |
| All Providers | Billing Update: 2020 CPT-4 Annual Update | December 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Incontinence Medical Supplies | December 2019 |
| All Providers | Update: Prop 56 Supplemental Payment | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Acyclovir Injection | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Buprenorphine | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Spinal Canal Ultrasound | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Internal (Female) Condoms | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Intrauterine Devices and Contraceptive Implant | November 2019 |
| DME | Policy Update: Frequency Updates for DME Codes | November 2019 |
| Physicians, Outpatient Hospitals, Long Term Care, Clinics and DME | Billing Update: List of Contracted Intermittent Urinary Catheters | November 2019 |
| DME | Billing Update: DME Supply Codes | November 2019 |
| DME | Billing Update: Wound Care Advance Dressing | November 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Evocative and Suppression Panel Tests | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Scleral Contact Lens | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Skin Substitute Products | October 2019 |
| All Providers | Policy Update: Onasemnogene Abeparvovec-xioi | October 2019 |
| Physicians, Outpatient Hospitals, Pharmacy and Clinics | Policy Update: End of Life Option Act Services | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Induce Abortion | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: BRAF Gene Analysis | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Gene Analysis | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Microbiology | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Cough Stimulating Device | October 2019 |
| All Providers | Update: Provider Manual Revisions | October 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Postpartum Office Visits | September 2019 |
| DME | Policy Update: CPAP and Bi-PAP Providers | September 2019 |
| All Providers | Billing Update: 2020 ICD-10/PCS Code Annual Update | September 2019 |
| All Providers | New Benefit: Fractional Exhaled Nitrous Oxide | August 2019 |
| All Providers | Benefit Removed: BCG Vaccine | August 2019 |
| All Providers | Benefit Removed: HCPCS Code J0604 | August 2019 |
| DME | Rate Update: Allied Health and Other Programs | August 2019 |
| All Providers | Policy Update: Family PACT Programs | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Radium Ra-223 Dichloride | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Abatacept Injection | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Avelumab Injection | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Bendamustine HCI | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Ovarian Oncology Biochemical Assays | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Iron Sucrose Injection | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Ipilimumab | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Infliximab Injection | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Evaluation Management Codes | August 2019 |
| All Providers | News: Crossover Claims | August 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Counseling to prevent Perinatal Depression | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: July 2019 HCPCS Quarterly Update | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Radiology Services | July 2019 |
| DME | Rate Update: Allied Health and Other Programs | July 2019 |
| All Providers | Policy Update: Early and Periodic Screening, Diagnostic and Treatment (EPSDT) | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Omalizumab Injection | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Nusinersen Injection | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Nivolumab Injection | July 2019 |
| DME | Policy Update: Underwear Incontinence Supply | July 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Diabetes Prevention Program (DPP) | July 2019 |
| All Providers | News: Diabetes Prevention Program (DPP) | June 2019 |
| All Providers | News: Diabetes Prevention Providers New to Medi-Cal | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Hepatitis B Vaccine | June 2019 |
| DME | New Benefit: Oral Appliance for Obstructive Sleep Apnea | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Mepolizumab HCPCS code J2182 | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Buprenorphine Implant | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: KIR (killer cell immunoglobulin-like receptor) | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Ipilimumab HCPCS Code J9928 | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Hydroxyprogesterone Caproate | June 2019 |
| Physicians and Clinics | Policy Update: Dental Services Updated for FQHC, RHC and IHS-MOA Clinic Providers |
June 2019 |
| DME | Policy Update: Brest Pump Supplies | June 2019 |
| All Providers | Billing Update: NICU/PICU Services Code Conversion | June 2019 |
| All Providers | Billing Update: EPSDT Psychology, Mental & Behavioral Health | June 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: April 2019 HCPCS Quarterly Update | May 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Breast Cancer Gene Analysis | May 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: SMN1 Gene Analysis | May 2019 |
| All Providers | Policy Update: Reslizumab Injection | May 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: EPSDT Psychology, Mental Health & Behavioral Health Code Conversion | May 2019 |
| All Providers | Billing Update: NICU/PICU Services Code Conversion | May 2019 |
| All Providers | Billing Update: CCS Service Code Groupings | May 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Physician Administered Drugs | April 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: NICU/PICU Services Code Conversion | April 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Audiology/EPSDT Audiology/Speech Theraphy Code Conversion | April 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: EPSDT Psychology, Mental Health & Behavioral Health Code Conversion | April 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: NICU/PICU Sevices Codes Conversion SAR/eSAR Requirements | April 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Requirements for Tocilizumab | April 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Targeted Genomic Sequence Analysis | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Epoetin Beta ERSD Therapy | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Modifier UA and UB Rates | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Unlisted Multianalyte Assays | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Intravitreal Implants | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Modifiers Override Medical Justification Requirement | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Alcohol Misuse Screenings | March 2019 |
| DME | Policy Update: Tumor Treating Field Devices | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Blood Factor Rebinyn | March 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Proposition 56 Supplemental Payment | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | News: Diabetes Prevention Program (DPP) | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: NICU/PICU Services | February 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Sign Language Interpreter Services | February 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Advance Care Planning | February 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Audiology, EPSDT Audiology and Speech Therapy | February 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Transportation Services | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Molecular Pathology Procedures | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Thyroid Gene Expression Analysis | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: CPT-4 Code 81329 | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Bright Futures/AAP Preventative Screening | February 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Laboratory Services | February 2019 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Cladribine (HCPCS Code J9065) | January 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: 2019 HCPCS Annual Update | January 2019 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Correction to 2019 CPT Annual Update | January 2019 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: USPSTF and ACIP Preventative Services | January 2019 |
ARCHIVE - 2018 Recent Billing/Policy Update Articles
Here you will find previously posted 2018 articles from the “Recent Billing/Policy Updates” section
| Attention |
ARCHIVED 2018 Recent Billing/Policy Update Articles |
Original Posting Date |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Diabetes Prevention Program | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | New Benefit: Chronic Care Management Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | New Benefit: EContra Emergency Contraceptive Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: 2019 CPT Annual Update | December 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: October 2018 HCPCS Quarterly Update | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: EPSDT Home Health Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: Revenue Codes for Outpatient Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: Sign Language Interpreter Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: Maternal Care Services and CPSP | December 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: NICU/PICU Services | December 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Updates: EPSDT Psychology, Mental & Behavioral Health | December 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Depression Screenings | November 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Diabetes Prevention Program | November 2018 |
| Physicians, Outpatient Hospitals, Clinics | Rate Updates: Corrected Rates for Select HCPCS Codes | November 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Updates: Cervical Cancer Screenings and HPV Testing | November 2018 |
| DME Providers | Policy Updates: Insulin Pumps | November 2018 |
| DME Providers | Policy Updates: CPAP and Bi-PAP Equipment | November 2018 |
| DME Providers | Policy Updates: Breast Pumps and Supplies | November 2018 |
| DME Providers | Billing Update: Disposable Insulin Delivery System | November 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: TPMT Gene Analysis | October 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: 2018 ICD-10-PCS Annual Update | October 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: EPSDT Psychology, Mental Health and Behavioral Health | October 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: Audiology, EPSDT Audiology and Speech Therapy | October 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: Sign Language Interpreter Services | October 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Rate Update: Newborn Screening Rate | October 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Rate Update: Pathology Service Codes | October 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Fetal Non-Stress Testing | September 2018 |
| Physicians, Outpatient Hospitals, Clinics | New Benefit: April HCPCS Quarterly Update | September 2018 |
| Physicians, Outpatient Hospitals, Clinics | New Benefit: July HCPCS Quarterly Update | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Whole-Child Model Program | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: 2018 ICD-10-CM Diagnosis Code Annual Update | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: 2019 ICD-10-CM/PCS Diagnosis Code Annual Update | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Chemical Pathology | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Automated Hemogram and RSV Laboratory Tests | September 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: TAR Update for Skin Substitute | September 2018 |
| Anesthesiologist | Policy Update: Dental Conscious and Deep Sedation | September 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Molecular Pathology Codes | August 2018 |
| Physicians, Outpatient Hospitals, Clinics | Billing Update: EPSDT Home Health Code Conversion | August 2018 |
| Physicians, Outpatient Hospitals, Clinics | Policy Update: Self-Administered Hormonal Contraceptives | August 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Infectious Agent Detection Laboratory Codes | August 2018 |
| Transportation Providers | Policy Update: Non-Emergency Medical Transportation | August 2018 |
| Physicians, Outpatient Hospitals, Clinics | New Benefit: Skin Substitutes (HCPCS codes Q4159 & Q4160) | July 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Molecular Pathology (CPT-4 code 81310) | July 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Clinic Dispensing for Miscellaneous Drugs | July 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: HCPCS code G0433 Added to CIA-Waived List | July 2018 |
| Physicians, Outpatient Hospitals, Clinics | Policy Updates: Breast Pump Supplies | July 2018 |
| Physicians, Outpatient Hospitals, Clinics | Policy Update: Copper Intrauterine Devices (IUDs) | July 2018 |
| Transportation Providers | New Benefit: Non-Medical Transportation | June 2018 |
| Orthotics and Prosthetics Providers | Policy Update: Cranial Remolding Orthosis (HCPCS code S1040) | June 2018 |
| Outpatient Hospitals | Policy Update: Revenue Code Update for Outpatient Services | June 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Molecular Pathology Codes | June 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Lynch Syndrome Testing (CPT-4 code 81403) | June 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Brest Oncology Profiled via RT-PCR (CPT-4 code 81519) | June 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Clinical Laboratory Services | June 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: CPT-4 Codes Annual Update Correction | June 2018 |
| DME Providers | Policy Update: DME for Disabled Parents to Assist with Child Care | June 2018 |
| DME Providers | Policy Update: Power Wheelchair Nonstandard Set Frames (HCPCS codes E2340 – E2343) | June 2018 |
| DME Providers | Policy Update: Power Seat Elevators | June 2018 |
| DME Providers | Policy Update: Seating and Positioning Component Coverage | June 2018 |
| DME Providers | Policy Update: Select Blood Pressure Equipment (HCPCS codes A4660 & A4663) | June 2018 |
| Transportation Providers | Policy Update: Medical Transportation (Dry Runs) | June 2018 |
| Transportation Providers | Policy Updates: Emergency Air and Ground Transportation | June 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Newborn Screening (HCPCS code S3620) | June 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Skin Substitute Products (HCPCS codes Q4131, Q4132 and Q4133) | June 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Specified Apheresis Procedures | June 2018 |
| Primary Care Providers | Rate Update: Preventative Medicine Evaluation and Management (CPT-4 codes 99385 & 99395) | June 2018 |
|
Anesthesiologist |
Rate Update: Certain Anesthesia Services | June 2018 |
| Hospice Providers | Rate Update: Hospice Care Providers | June 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: PL and PS Modifier on Pathology Codes | May 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: Revenue Codes for Outpatient Services | May 2018 |
| Physicians, DME, Orthotics & Prosthetics, and Physical Therapy | Billing Update: Updated Modifiers for Oxygen Codes | May 2018 |
| Physicians, DME, Orthotics & Prosthetics, and Physical Therapy | Billing Update: Updated Diagnosis Codes for Removable Foot Inserts | May 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Clinical Criteria for DNA Sequence Analysis | May 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Clinical Criteria for Familial Hyperinsulinism Gene Analysis | May 2018 |
| Physicians, DME, Orthotics & Prosthetics, and Physical Therapy | Policy Update: Frequency limitation for Orthotic Codes | May 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: FLT3 Gene Analysis (81245 and 81246) | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Alcohol Misuse (G0442 and G0443) | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics, Transportation | Billing Update: Non-Emergency Medical Transportation | April 2018 |
| Hospice Providers | Billing Update: Hospice Routine Home Care (0650, 0659 and 0552) | April 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: HPV Testing and Co-Testing (87624 and 87625) | April 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Breast Cancer Gene Analysis (81162, 81211 and 81213) | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Vitamin B-12 Injections (J3420) | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Diclofenac Sodium Injection (J1130) | April 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Newborn Metabolic Screening Panel | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Rate Update: Family Planning Drugs (J3490) | April 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Proposition 56 Supplemental Payments | April 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Additional Gene Tests Billable under Molecular Pathology CPT-4 codes (81406,81404 and 81405) | March 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | New Benefit: Surgical Pathology (88365) | March 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Nerve Pedicle Transfer (64905) | March 2018 |
| Physicians, Outpatient Hospitals, and Clinics, Transportation | Policy Update: Medical Transportation Dry Runs (A0225) | March 2018 |
| Physicians, Outpatient Hospitals, and Clinics, Home Health Agencies | Policy Update: Face to Face Encounters for Home Health Services | March 2018 |
| Physicians, DME, Orthotics & Prosthetics, and Physical Therapy | Rate Update: Knee Orthosis Codes (L1851 and L1852) | March 2018 |
| ALL PROVIDERS | 2017 and 2018 CPT-4/HCPCS Update | February 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Microsatellite Instability Analysis (81301) | February 2018 |
| Physicians, DME, Orthotics & Prosthetics, and Physical Therapy | Policy Update: Wheelchair and Scooter Repair and Maintenance | February 2018 |
| ALL PROVIDERS | Annual 2018 CPT-4/HCPCS Code Update | January 2018 |
| Physicians, Outpatient Hospitals, and Clinics | New Benefit: Pulmonary Rehabilitation (G0424) | January 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Upcoming Benefit: Diabetes Prevention Program | January 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Policy Update: Mammography Codes 77065 and 77066 | January 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Policy Update: Neuropsychological Testing | January 2018 |
| Physicians, Outpatient Hospitals, and Clinics | Billing Update: Place of Service Code Update on Sleep Study and Polysomnography Codes | January 2018 |
| Physicians, Outpatient Hospitals, Clinics, Vision Providers, and Ophthalmologists | Billing Update: Ophthalmic Biometry (92136) | January 2018 |
| Physicians, Outpatient Hospitals, Clinics, and Laboratories | Billing Update: KIT Gene Analysis (81272) | January 2018 |