California Medi Cal Industry News articles

A previously published Medi-Cal Update added, changed and deleted CPT-4 codes for the 2018 annual update, effective February 1, 2018. Corrections to this policy are as follows:

CPT-4 codes 71045 – 71048, 74018, 74019 and 74021 do not require an approved Treatment Authorization Request (TAR) to be split-billed.

INDUSTRY NEWS TAGS:Radiology California Medi Cal Payor

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Effective for dates of service on or after June 1, 2018, the following ICD-10-CM diagnosis codes are added to the list available for procedure codes related to genetic testing for Lynch syndrome. One diagnosis code is required.

 

C17.0 – C17.9

C65.1 – C66.9

 

C24.0 – C24.9

INDUSTRY NEWS TAGS:California Medi Cal Molecular Diagnostics

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EPC Letters – May 2018

These adjustments will appear on Remittance Advice Details (RAD) forms beginning May 17, 2018 (for positive adjustments), and June 7, 2018 (for negative adjustments), with RAD code 0893: Retroactive rate adjustment.

INDUSTRY NEWS TAGS:Payor California Medi Cal

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EPC Letters – May 2018

The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with CPT-4 code 87902 (infectious agent genotype analysis by nucleic acid; Hepatitis C virus).

INDUSTRY NEWS TAGS:Payor California Medi Cal

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Effective for dates of service on or after October 1, 2017, the following CPT codes are no longer reimbursable by the Every Woman Counts (EWC) program: 77055-77057. Effective for dates of service on or after October 1, 2017, the following CPT codes are reimbursable by the EWC program: 77065-77067. The Medi-Cal claims processing system is being updated to process claims with CPT codes 77065 – 77067. Once the system is ready, denied claims submitted for dates of service on or after October 1, 2017, will be subject to an Erroneous Payment Correction (EPC).

INDUSTRY NEWS TAGS:Radiology News California Medi Cal

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Effective for dates of service on or after December 1, 2017, an approved Treatment Authorization Request (TAR) will no longer override the once-in-a-lifetime limitations of pathology CPT codes 81435 Hereditary colon cancer disorders; genomic sequence analysis panel, must include sequencing of at least 10 genes, including APC, BMPR1A, CDH1, MLH1, MSH2, MSH6, MUTYH, PTEN, SMAD4, and STK11 and 81436 Hereditary colon cancer disorders; duplication/deletion analysis panel, must include analysis of at least 5 genes, including MLH1, MSH2, EPCAM, SMAD4, and STK11.

INDUSTRY NEWS TAGS:California Medi Cal

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Effective for dates of service on or after December 1, 2017, Treatment Authorization Request (TAR) criteria have been updated for CPT codes 81211 (BRCA1, BRCA2 gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1), 81213 (...uncommon duplication/deletion variants) and 81162 (...full sequence analysis and full duplication/deletion analysis). The once-in-a-lifetime frequency limitation can be overridden with a TAR that meets certain requirements.

INDUSTRY NEWS TAGS:California Medi Cal

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The Department of Health Care Services (DHCS) identified a claims processing issue affecting Medicare/Medi-Cal crossover claims for outpatient services. This issue caused some crossover claims to under pay. The issue affected claims for dates of service from January 1, 2016, through September 30, 2016. No action is required on your part. Conduent will adjust the affected claims. These adjustments will appear on Remittance Advice Details (RAD) forms beginning October 19, 2017, with RAD code 0824: Price correction, after erroneous quantity cutback.

INDUSTRY NEWS TAGS:California Medi Cal

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The Department of Health Care Services (DHCS) identified a claims processing issue affecting claims billed with split-billable procedure codes. This issue caused some claims to erroneously deny with Remittance Advice Details (RAD) code 0196: This procedure requires a modifier; modifier is not present. The issue affected claims for dates of service from August 1, 2015, through September 1, 2017. No action is required on your part. Conduent will resubmit the affected claims.

INDUSTRY NEWS TAGS:California Medi Cal

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The Department of Health Care Services (DHCS) identified a claims processing issue affecting certain outpatient and medical claims billed with National Correct Coding Initiative (NCCI) associated modifiers. This issue caused claims to erroneously pay. The issue affected claims for dates of service from August 1, 2015, through September 8, 2017. No action is required on your part. Conduent will void and resubmit the affected claims.

INDUSTRY NEWS TAGS:California Medi Cal

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