Claims Corner

claimscontactCenCal 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
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
ALL PROVIDERS STILL USING PAPER TO SUBMIT CLAIMS? January 2018
February 2018
February 2018
March 2018
March 2018
March 2018
Policy Update:  Diclofenac Sodium Injection
Policy Update: Copper Intrauterine Devices (IUDs)
Policy Update: Dental Conscious and Deep Sedation
Policy Update: Dental Conscious and Deep Sedation
September 2018 
October 2018
October 2018
October 2018
November 2018
November 2018
November 2018
December 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 Policy and/or Rate Changes. 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 Notifications Posting Date
ALL PROVIDERS   CenCal Health is not currently aware of any upcoming Diagnosis Updates 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
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 - 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
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
AcceptReject

ARCHIVE - 2017 Recent Billing/Policy Update Articles

Here you will find previously posted 2017 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2017 Recent Billing/Policy Update Articles Original Posting Date
Physicians, Outpatient Hospitals, and Clinics
New Benefit: Cuvitru for Primary Humoral Immunodeficiency (billable under HCPCS code J3590) December 2017
Physicians, Outpatient Hospitals, and Clinics
Billing Update: Modifier ZA (when billing Zorxio with HCPCS Code Q5101) December 2017

Physicians, Outpatient Hospitals, and Clinics
Policy Update: Bevacizumab 10 mg Injection (HCPCS Code J9035)
December 2017

DME, Orthotics & Prosthetics, and Physical Therapy
Policy Update: HCPCS code L3000 (Orthotic Foot Insert)  December 2017

Physicians, DME, Orthotics & Prosthetics, and Physical Therapy
Policy Update: Lower Extremity, Thoracic Control (HCPCS Codes L2670 and L2680) December 2017

Physicians, Outpatient Hospitals, and Clinics

Policy Update:  Cystourethroscopy Services (CPT-4 Codes 52441 and 52442) December 2017

Physicians, Outpatient Hospitals, and Clinics New Benefit: Nusinersen 0.1mg injection (C9489), Bezlotoxumab 10mg injection (C9490) and Ustekinumab, for intravenous injection, 1mg (Q9989) November 2017
Physicians, Outpatient Hospitals, and Clinics Billing Update: Modifier ZB (when billing Inflectra with HCPCS Code Q5102) November 2017
Physicians, Outpatient Hospitals, and Clinics Billing Update: Modifier ZC (when billing Renflexis with HCPCS Code Q5102) November 2017
Physicians, Outpatient Hospitals, Clinics, and Laboratories  Policy Update for Breast Cancer Gene Analysis (CPT-4 Codes 81211, 81213 and 81162) November 2017
Physicians, Outpatient Hospitals, Clinics, and Laboratories  Policy Update for Hereditary Colon Cancer Disorder (CPT-4 Codes 81435 and 81436) November 2017 
Physicians, Outpatient Hospitals, and Clinics, DME Policy Update: DME Wheelchair and Wheelchair Accessory Guidelines November 2017
Physicians, Outpatient Hospitals, and Clinics, DME and Obstetricians Policy Clarification: Rental/Purchase of Breast Pumps  November 2017
Physicians, Outpatient Hospitals, Clinics, Vision Providers, and Ophthalmologists Diagnosis Update for Professional Vision and Ophthalmology Services November 2017
Physicians, Outpatient Hospitals,  Clinics and Obstetricians Annual 2017 CPT4/HCPCS Code Update Revisions October 2017
Physicians, Outpatient Hospitals, and Clinics   Immunization and Vaccines FAQs October 2017
Physicians, Outpatient Hospitals,  Clinics and Obstetricians New Benefit: Pathogen(s) Test for Platelets HCPCS Code Q9987 October 2017
Physicians, Outpatient Hospitals, and Clinics   Rate Update for Skin Lesion Surgery CPT-4 Codes 17110 and 17111 October 2017
Physicians, Outpatient Hospitals, Clinics, Obstetricians and Laboratories  Policy Update for HIV Screening and Infectious Agent Detection HCPCS Code G0475 and CPT-4 Code 87801 October 2017
ALL PROVIDERS

Annual Update 2017 CPT-4/HCPCS Codes- Additional Information

September 2017
Physicians, Outpatient Hospitals, and Clinics    New Benefit: Siltuximab 10 mg Injection September 2017
Physicians, Outpatient Hospitals,  Clinics and Obstetricians New Benefit: Surgical and Preventative Preterm Birth HCPCS Codes (C9745-C9747 and Q9985-Q9986) September 2017 
Physicians, Outpatient Hospitals,  Clinics, Obstetricians and Gynecologists Policy Update for Sterilization CPT-4 Codes 58661 (Laparoscopy) and 58700 (Salpingectomy) September 2017
Physicians, Outpatient Hospitals,  and Clinics  Policy Update for Allergen Specific IgE Testing (CPT-4 Code 86003) September 2017
DME, Orthotics & Prosthetics, and Physical Therapy Policy Update for Several DME HCPCS Codes September 2017
Physicians, Outpatient Hospitals,  and Clinics  Billing Update: Cardiac Magnetic Imaging Resonance for Morphology (CPT-4 Code 75561) September 2017
Audiology, DME, Orthotics & Prosthetics, and Physical & Occupational Therapy Billing Update to Specific Orthotics & Prosthetics HCPCS Codes September 2017
Physicians, Outpatient Hospitals,   Clinics and FQHCs/RHCs/IHS-MOAs Billing Update: End of Life Option Services September 2017
FQHCs/RHCs/IHS-MOAs Billing Update for Service Authorization Requests (SARs) September 2017
Clinical Laboratories Rate Update for Clinical Laboratory Services  September 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories  Billing Update: Drug Testing HCPCS Codes G0477-G0479 to be Discontinued August 2017
 ALL PROVIDERS Annual Update for 2017 CPT-4/HCPCS Codes August 2017
Physicians, Outpatient Hospitals, Clinics and Ophthalmologists Policy Update for Eye and Ocular Adnexa Surgery (CPT-4 Codes 65778, 65779, 66820, 66821) August 2017
DME Providers Policy Update for Sterile Needles (HCPCS Code A4125) August 2017
FQHC, RHC and IHS-MOA Providers   Additional Information for HIPAA Conversion Update  August 2017
Physicians, Outpatient Hospitals, and Clinics    New Benefit:  Cardiac Magnetic Resonance Imaging  (CPT-4 Code 75561) July 2017
Physicians, Outpatient Hospitals, and Clinics   New Benefits under Physicians Administered Drugs (HCPCS Codes C9484-C9488)  July 2017
Physicians, Outpatient Hospitals, and Clinics    Policy Update for Modifier KX  July 2017
Physicians, Outpatient Hospitals, and Clinics  Policy Update for Lanreotide 1 mg Injection (HCPCS Code J1930)  July 2017
Physicians, Outpatient Hospitals, and Clinics   Rate Update for Pulmonary Valve Implantation (CPT-4 Code 33477)  July 2017
FQHC, RHC and IHS-MOA Providers  Billing Update: HIPAA Code Conversion Coming Soon July 2017
Physicians, Outpatient Hospitals, Clinics and Family Planning Providers New Benefit:  Contraceptive Cervical Cap and Diaphragm (HCPCS Codes A4261 and A4266)   June 2017
Physicians, Outpatient Hospitals, Clinics and Family Planning Providers  New Benefit:  Levonorgestrel-releasing Intrauterine System, 19.5 mg (HCPCS Code S4989)  June 2017
Physicians, Outpatient Hospitals, and Clinics    New Benefit: Procalcitonin Assay (CPT-4 code 84145) June 2017
ALL PROVIDERS New Benefit:  Modifier 95 June 2017
Indian Health Services Providers  Policy update for Acupuncture Services June 2017
Inpatient Hospitals  Policy Update for Emergency Room Reimbursement Policy June 2017
Physicians, Outpatient Hospitals, Clinics and DME Providers  Policy Update for DME Prescriptions June 2017
Physicians, Outpatient Hospitals, Clinics and DME Providers 
Policy Update for Medical/Incontinence Supplies and Enteral Nutrition Prescriptions June 2017
Physicians, Outpatient Hospitals, and Clinics  Policy Update for ECMO/ECLS Services June 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians  Policy Update for Pregnancy Services June 2017
Physicians, Outpatient Hospitals, Clinics and Obstetricians   Policy Update for Select Ultrasound Services (CPT-4 Codes 76514, 76830, 76856 and 76857)  June 2017
Physicians, Outpatient Hospitals, and Clinics 
Policy Update for Zoster Vaccine (CPT-4 codes 90736)  June 2017
Physicians, Outpatient Hospitals, and Clinics 
Policy Update for Allergen Immunotherapy Injections (CPT-4 Codes 95115 and 95117) June 2017
DME Providers Policy Update for Blood Pressure Monitor (HCPCS Code A4670)  June 2017
DME Providers  Policy Update for DME Oxygen and Respiratory Equipment June 2017
Physicians, Outpatient Hospitals, and Clinics   Rate Update for Ureter and Urethra Surgery Services (CPT-4 Codes 52441, 52442, 53850 and 53852 June 2017
Physicians, Outpatient Hospitals, and Clinics  
Rate Update for Application of Topical Fluoride Varnish (CPT-4 Code 99188) June 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories  
New Benefit:  SMN1/SMN2 Gene Test  (CPT-4 Code 81401) May 2017
Physicians, Outpatient Hospitals and Clinics
Diagnosis Restrictions Update for Bevacizumab 10 Mg Injection (HCPCS code J9035)  May 2017
DME Providers  Policy Update for Medical Supply Invoices May 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories  Medi-Cal Rate Update for CPT-4 codes 88112 (Cytopathology, Selective Cellular Enhancement Technique) and 88333 (Pathology Consultation during Surgery) May 2017
Physicians, Outpatient Hospitals and Clinics  Medi-Cal Rate Update for CPT-4 code 11042 (debridement, subcutaneous tissue) May 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories   Policy Clarification for SMN1 Gene Tests (CPT-4 Codes 81400, 81403 & 81405)  May 2017
Physicians, Outpatient Hospitals and Clinics UPDATE: HIPAA Conversion of Intravenous Solutions (Local Codes X7700 & X7702)  April 2017
Physicians, Outpatient Hospitals and Clinics New Benefit:  Carbidopa and Levodopa Enteral Suspension (HCPCS Code J7340)  April 2017
Physicians, Outpatient Hospitals, Clinics, Family Planning Providers  Policy Update for Clinic Dispensing of Contraceptive Supplies (HCPCS Codes J7303 and J7304)  April 2017 
DME Providers  Policy Update for Obstructive Sleep Apnea (OSA)  April 2017
Medical Transportation Providers  Policy Update for Medical Transportation related to Emergency Statements, Round Trips, Night Calls and Non-Emergency Transports April 2017
Physicians, Outpatient Hospitals, Clinics and Radiologists  
New Benefit: Abdominal Ultrasound Services (HCPCS Code C9744) March 2017
Physicians, Hospitals and Clinics  Policy Update for ECMO and ECLS Services  March 2017
Physicians, Outpatient Hospitals, and Clinics    HIPAA Conversion for Inhalation Solutions (Local Codes X7700 and X7702)  March 2017
Physicians, Outpatient Hospitals, and Clinics  
Policy Update for Central Nervous System Assessments/Tests  February 2017
DME Providers  Pricing Policy Update for Wheelchair Accessory February 2017
DME and Prosthetics & Orthotics Providers  Policy Update for HCPCS L1902 (Prefabricated Ankle Orthosis) February 2017
ALL PROVIDERS
Policy Update for Revenue Codes  January 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories    New Benefit:  EndoPredict (CPT-4 Code 81599) January 2017
Physicians, Outpatient Hospitals, and Clinics   New Flu Vaccine: Flucelvax (CPT-4 Code 90674) January 2017
Physicians, Outpatient Hospitals, and Clinics   New Injection Codes:  Atezolizumab (HCPCS Code C9483), Reslizumab (HCPCS Code C9481) and Sotalol (HCPCS Code C9482)   January 2017
Physicians, Outpatient Hospitals, Clinics and Allergy Providers  Policy Update for Allergy Desensitization Services (CPT-4 Codes 95115 and 95117) January 2017
Physicians, Outpatient Hospitals, Clinics and Laboratories     Policy Update for Colorectal Cancer Screening (CPT-4 codes 81528)  January 2017
Podiatrists  Policy Clarification for Podiatry Services  January 2017