Medi-Cal: Medi-Cal Update - General = Medicine | May 2008

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Medi-Cal Update

General Medicine

May 2008 | Bulletin 407=20

Contents=20

Medi-Cal Training Seminars [PDF] =E2=80=93 Mark = your calendar for=20 the upcoming Medi-Cal Training Seminar in your area.

Revised=20 Proprietary Forms Reminder =E2=80=93 New versions of Medi-Cal and = Child Health and=20 Disability Prevention (CHDP) program proprietary forms are available = from=20 Medi-Cal.

Contraceptive=20 Implant Implanon is New Benefit =E2=80=93 Effective retroactively = for dates of=20 service on or after January 1, 2008, Implanon contraceptive implant is a = Medi-Cal benefit.

Essure=C2=AE=20 System ESS305 =E2=80=93 New Birth Control Benefit =E2=80=93 = Effective retroactively to=20 January 1, 2008, CPT-4 code 58565 (hysteroscopy; with bilateral = fallopian tube=20 cannulation to induce occlusion by placement of permanent implants) is a = Medi-Cal benefit.

Ultrasound=20 Policy Expanded to Include Abortions =E2=80=93 Effective = retroactively for dates of=20 service on or after March 1, 2005, the following ultrasound codes can = now be=20 billed as payment for the treatment of spontaneous abortions (using = diagnosis=20 codes 634.00 =E2=80=93 634.92) and unspecified abortions, which include = complete,=20 incomplete and inevitable abortions (using diagnosis codes 637.00 = =E2=80=93 637.92).

Rate=20 Increase for Mirena Intrauterine System=C2=AE =E2=80=93 Effective = retroactively to=20 September 24, 2007, the rate for HCPCS code X1532 (Mirena Intrauterine = System=C2=AE=20 [IUS]) is increased from $420.33 to $468.71.

Extended=20 Presumptive Eligibility Coverage Update =E2=80=93 Effective for = dates of service on=20 or after June 1, 2008, a qualified provider is no longer required to = contact the=20 Presumptive Eligibility (PE) Support Unit for approval of PE coverage=20 extensions.

CPT-4=20 Codes 88147 and 88148 Billing Restrictions Update =E2=80=93 = Retroactive for dates of=20 service on or after October 1, 2006, CPT-4 codes 88147 (cytopathology = smears,=20 cervical or vaginal; screening by automated system under physician = supervision)=20 and 88148 (screening by automated system with manual rescreening under = physician=20 supervision) are split-billed and may be billed with modifiers 26, TC or = ZS.

Pathology=20 Tests Billing Update =E2=80=93 Effective for dates of service on or = after May 1,=20 2008, in regards to CPT-4 codes 80061 (lipid panel test) and 83721 (LDL=20 cholesterol test), if the triglyceride level of the recipient is less = than 400=20 mg/dl and both CPT-4 codes 80061 and 83721 are billed on the same date = of=20 service, for the same recipient, and by the same provider, the claim = will be=20 subject to a combination audit that will cut back the reimbursement so = as only=20 code 80061 is reimbursed.

CPT-4=20 Code 38204 Billing Reminder =E2=80=93 Providers are reminded that = CPT-4 code 38204=20 (management of recipient hematopoietic progenitor cell donor search and = cell=20 acquisition) must be billed with a surgery modifier, for example, = modifier AG=20 (primary physician).

Colorectal=20 Cancers Drug Policy Updated =E2=80=93 Effective for dates of service = on or after=20 June 1, 2008, HCPCS codes J9035 (bevacizumab 10 mg), J9263 (oxaliplatin = 0.5 mg),=20 X7636 (irinotecan 100 mg), and X6446 (leucovorin calcium 10 mg/ml) will = no=20 longer be reimbursed for the treatment of anus and anal cancer (ICD-9-CM = diagnosis codes 154.2 =E2=80=93 154.8).

Bevacizumab=20 (Avastin=C2=AE) Injection Policy Update =E2=80=93 Effective for = dates of service on or=20 after June 1, 2008, diagnosis of malignant neoplasm of the female breast = (ICD-9-CM 174.0 =E2=80=93 174.9) has been added to the list of allowable = diagnoses for=20 the reimbursement of HCPCS code J9035 (injection, Bevacizumab, 10 = mg).

Vinorelbine=20 Reimbursement Expanded =E2=80=93 Effective for dates of service on = or after June 1,=20 2008, HCPCS code X7580 (vinorelbine 10 mg per 1 ml) will be replaced = with HCPCS=20 code J9390 (vinorelbine tartrate, per 10 mg.

Radiology=20 and Laboratory Modifier Update =E2=80=93 Effective for dates of = service on or after=20 July 1, 2008, laboratory and radiology codes will be identified as = either=20 split-billable services or services that are not split-billable.

Specialty=20 Mental Health HCPCS Codes End-Dated =E2=80=93 Effective for dates of = service on or=20 after March 1, 2008, the following specialty mental health HCPCS codes = are not=20 reimbursable through the Medi-Cal claims payment system.

CCS=20 Service Code Groupings Update =E2=80=93 Effective for dates of = service on or after=20 April 1, 2008, CPT-4 code 65770 has been added to the California = Children=E2=80=99s=20 Services (CCS) Service Code Groupings (SCGs) 10.

Fresno=20 Medi-Cal Field Office Closure Reminder =E2=80=93 Effective March 7, = 2008, the=20 Department of Health Care Services (DHCS) closed the Fresno Medi-Cal = Field=20 Office (FMCFO), located at 3374 East Shields Avenue, Suite C-4, Fresno, = CA=20 93726.

Family=20 PACT Billing Update for CPT-4 Code 88141 =E2=80=93 This article = originally appeared=20 in the April 2008 Medi-Cal Update and Family PACT Update=20 bulletins.

Family=20 PACT: Provider Orientation and Update Session =E2=80=93 Medi-Cal = providers seeking=20 enrollment in the Family PACT (Planning, Access, Care and Treatment) = Program are=20 required to attend a Provider Orientation and Update Session.

Medi-Cal=20 List of Contract Drugs =E2=80=93 The following provider manual = section has been=20 updated: Drugs: Contract Drugs List Part 1 =E2=80=93 Prescription = Drugs.

Pages updated/corrected due to ongoing provider manual=20 revisions:
Declaraci=C3=B3n de Residencia en California = (MC 263 S-R [SP])=20 1
Drug use review (DUR) Manual 10-1 thru = 10-4
Explanation of Ineligibility for Presumptive = Eligibility=20 (MC 267) 1
Forms Order =E2=80=93 Presumptive Eligibility = (MC 285) 1=20
Presumptive Eligibility Provider Fact Sheet = 1
Statement of California Residency (MC 263 S-R)=20 1
presum 15/16, 19/20
subacut adu 3/4

Note:=20

If you cannot view the MS Word or PDF (Portable = Document=20 Format) documents correctly, please visit the Web Tool = Box to=20 link to a download site for the appropriate reader.