Billing Beat

Medi-Cal – 2020 Quarter 3 CPT and HCPCS Updates Not Yet Adopted

July 6, 2020

The 2020 Quarter 3 updates to the Current Procedural Terminology – 4th Edition (CPT®) and Healthcare Common Procedure Coding System (HCPCS) Level II codes are effective for Medicare on July 1, 2020. However, Medi-Cal has not yet adopted the 2020 Quarter 3 updates.

Provider should not use the 2020 Quarter 3 codes to bill for Medi-Cal or Presumptive Eligibility for Pregnant Women (PE4PW) services until notified to do so in a future Medi-Cal Update.

Effective July 1, 2020, providers are also directed to stop submitting claims for HCPCS code J3590 (unclassified biologics) when billing for onasemnogene abeparvovec-xioi (Zolgensma). Processing of claims for code J3399 (injection, onasemnogene abeparvovec-xioi, per treatment, up to 5×10^15 vector genomes) will be delayed until the code has been adopted.

Source: https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30541_01.aspx

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