Providers are reminded that retroactively effective for dates of service on or after September 1, 2006, CPT-4 code 87900 (infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics) is not separately reimbursable with codes 87903 (infectious agent phenotype analysis by nucleic acid, [DNA or RNA] with drug resistance tissue culture analysis, HIV 1;...
Code Current Narrative Medicare Initiated N430 Procedure code is inconsistent with the units billed. Start: 11/5/2007 Note: (New Code 11/5/07) YES N431 Service is not covered with this procedure. Start: 11/5/2007 Note: (New Code 11/5/07) YES N432 Adjustment...
Providers are reminded that once a claim is submitted with a National Provider Identifier (NPI), the associated Medi-Cal "legacy" provider number(s) will be end-dated. In other words, effective for dates of service beyond the date of a claim submitted with an NPI, the Medi-Cal provider number will no longer be valid. Using the associated Medi-Cal provider number(s) following a claim...
Retroactive to dates of service on or after September 4, 2007, the Trofile test is a Medi-Cal benefit and can be billed using CPT-4 code 87999 (unlisted microbiology procedure). Current Medi-Cal reimbursement for this code is "By Report." This blood test is available for recipients with diagnosed Acquired Immune Deficiency Syndrome (AIDS) who have evidence of viral replication and HIV-1...
Effective for dates of service on or after January 1, 2008, procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]), when billed with modifier QW, is no longer a benefit of the Medi-Cal program. Claims billing 87210 with the QW modifier will be denied.
The effective date for the diagnosis restriction policy for Procedure Code 82607 (cyanocobalamin, [vitamin B-12]) has been changed from June 1, 2003 to January 1, 2007.
The Department of Health Care Services (DHCS) is extending the current dual-use period, which began on May 23, 2007, to continue beyond the NPI implementation date. Effective November 26, 2007, the NPI implementation date, a Medi-Cal provider number will continue to be required, even though the NPI is also being requested. Failure to include the Medi-Cal provider number beyond the NPI...
In the August 2007 Medi-Cal Update, restrictions for billing CPT-4 codes 83001 (gonadotropin; follicle stimulating hormone [FSH]) and 83002 (Éluteinizing hormone [LH]) were announced, including diagnostic billing code requirements. Effective for dates of service on or after September 1, 2007, additional gender restrictions apply to the diagnostic codes listed below when billed in conjunction with...
Effective for dates of service on or after October 1, 2007, CPT-4 code 82728 is reimbursable only when billed in conjunction with one of the following ICD-9-CM diagnosis codes: Modified CP Pairs 001 - 009.93 010 - 018.96 042 070 - 070.9 080 - 088.9 090 - 099.9 110 - 118 120 -...
Effective September 1, 2007, documentation requirements for fetal fibronectin testing (CPT-4 code 82731) will change. You no longer need to document in the Reserved for Local Use field (Box 19) of the claim that the patient is symptomatic for pre-term labor. Entering ICD-9-CM diagnosis code 644.03 (premature labor after 22 weeks but before 37 weeks of completed gestation without delivery) in the...
Beginning September 17, 2007, claims received on the old HCFA 1500 or UB-92 claim forms will be rejected and returned to the provider. Providers must submit claims on the new CMS-1500 or UB-04 claim form to avoid rejection. Medi-Cal implemented the use of the CMS-1500 and UB-04 claim forms on June 25, 2007. Unfortunately, some providers continue to submit claims on the old forms, so the...
Effective for dates of service on or after September 1, 2007, HCPCS code S3626 (maternal serum quadruple marker screen including Alpha-Fetoprotein [AFP], estriol, human Chorionic Gonadotropin [hCG] and Inhibin A) replaces HCPCS code S3625 (maternal serum triple marker screen including Alpha-Fetoprotein [AFP], estriol and human Chorionic Gonadotropin [hCG]) as a Medi-Cal benefit. This test is...
Effective for dates of service on or after September 1, 2007, the following procedure codes are benefits of the Presumptive Eligibility (PE) program: 80101 Drug screen, qualitative; single drug class method 86703 Antibody, HIV-1 and HIV-2, single assay 87086 Culture, bacterial; quantitative colony count, urine 87088 Culture, bacterial; with isolation and presumptive...
Effective August 1, 2007, Medi-Cal will adopt the 2007 CPT-4 and HCPCS Level II codes. Claims billed for dates of service on or after August 1, 2007 must use the appropriate 2007 codes.
Effective for dates of service on or after August 1, 2007, CPT-4 codes 83001 (gonadotropin; follicle stimulating hormone [FSH]) and 83002 (Éluteinizing hormone [LH]) are reimbursable only when billed in conjunction with one of the following ICD-9-CM diagnosis codes: 072.0 147.0 170.0 174.0 - 175.9 183.0 - 183.9...
Medi-Cal implemented the use of the CMS-1500 claim form on June 25, 2007. Providers who previously submitted claims on the HCFA 1500 must bill on the new CMS-1500 claim form immediately. Providers not using the new CMS-1500 should be in the process of transitioning. Failure to use the new form for claims submitted after June 25, 2007 may result in rejection of the provider's claim
The Family PACT (Planning, Access, Care and Treatment) Program will release its new provider manual in October 2007. This new manual will replace the current Policies, Procedures and Billing Instructions (PPBI) manual. All enrolled Family PACT Program providers will automatically receive an initial copy of the new Family PACT Program provider manual at no charge.
The following CPT-4 codes must be billed with the appropriate split-bill modifiers (26, 99, TC or ZS): 82107, 83698, 83913, 86788, 86789, 87305, 87498, 87640, 87641, 87653 and 87808. Code 88314 is not reimbursable with codes 17311 Ð 17315 for a routine frozen section stain. However, it is separately reimbursable for a non-routine frozen section stain when it is billed with modifier 59. Codes...
From April 23, 2007 to June 24, 2007, Medi-Cal will accept both the HCFA 1500 and CMS-1500 form. Providers using the HCFA 1500, however, can only enter their Medi-Cal provider number. Providers may choose to fully transition to the new CMS-1500 claim form at any time during this two-month period before the use of the CMS-1500 becomes mandatory. Beginning June 25, 2007, Medi-Cal will only accept...
Effective for dates of service on or after July 1, 2007, the following nonspecific ICD-9-CM diagnosis codes are not billable with a laboratory procedure code: V70, V70.0, V70.5 Ð V70.9, V72, V72.1 and V72.9. This does not change the policy that any laboratory procedure must be billed with a diagnosis code, nor does it change the policy requiring specific diagnosis codes for certain laboratory...