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
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
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 

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.

September 2018

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
Physicians, Outpatient Hospitals and Clinics    Policy Update for Moderate Sedation (CPT-4 Codes 99153 & 99157) September 2018
Physicians, Outpatient Hospitals and Clinics  Policy Update for Skin Substitutes (HCPCS Codes Q4176-Q4182)  September 2018
Physicians, Outpatient Hospitals and Clinics
 Policy Update for Specific Benefit Codes (CPT-4 Codes 91299, 92018 & 92019) July 2018
DME Providers Policy update for High Frequency Chest Wall Oscillation Device (HCPCS Code E0483) June 2018
Physicians, Outpatient Hospitals and Clinics  Policy Update for Depression Screening June 2018

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.
September 2018

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 - 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
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

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

ARCHIVE - 2016 Recent Billing/Policy Update Articles

Here you will find previously posted 2016 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2016 Recent Billing/Policy Update Articles Original Posting Date
Physicians, Outpatient Hospitals, Clinics and Radiologists 
New Benefit:  Pet Scan Diagnostic Agents Flutemetamol (HCPCS Code Q9982) and Florbetaben (HCPCS Code Q9983) December 2016
Physicians, Outpatient Hospitals, Clinics and Laboratories    Policy Update for Helicobacter Pylori (CPT-4 Code 87338) December 2016
Physicians, Outpatient Hospitals and Clinics  New Benefit: Various Physician-Administered Drugs November 2016
Physicians, Outpatient Hospitals and Clinics 
2017 ICD-10 Update for Family Planning Services  November 2016
Physicians, Outpatient Hospitals and Clinics   Policy Update for Darbepoetin Alfa (HCPCS Code J0882) November 2016
Hospitals, Physicians and Clinics  Policy Update for Gender Dysphoria Treatment November 2016
Physicians, Outpatient Hospitals, Clinics and Laboratories   Policy Update for Noninvasive Prenatal Testing Coverage (CPT-4 Codes 81420, 81479 & 81507)  November 2016
Obstetricians, Physicians, Outpatient Hospitals and Clinics Policy Update for Certified Nurse Midwives (CNM) - Cesarean Delivery "Assistant at Surgery" November 2016
DME Providers  Correction to Policy for DME Separately Reimbursable Items for LTC Recipients  November 2016
Physicians, Outpatient Hospitals and Clinics   Diagnosis Update for Fetal Congenital Abnormalities (CPT-4 Codes 81508-81512) November 2016
Physicians, Outpatient Hospitals and Clinics  
Diagnosis Update for Nerve Conduction Studies (CPT-4 Codes 95905, 95907-95912)  November 2016 
Physicians, Outpatient Hospitals and Clinics    Rate Update for Medical Nutrition Therapy (CPT-4 Code 97804)
November 2016
Hospitals, Physicians, Clinics and Radiologists New Benefit:   Functional MRI Brain Mapping (CPT-4 Codes 70554, 70555 & 96020) October 2016
Cardiologists, Physicians, Outpatient Hospitals and Clinics   Policy Update for Cardiology Service Codes (CPT-4 Codes 92920-92979, 92992-92998, 93451-93533 and 93561-93657) Billable with Modifier 53 (discontinued procedure) October 2016
Physicians, Outpatient Hospitals, Clinics and Laboratories    Policy Update for Laboratory Codes (CPT-4 Codes 80000-89999) Billable with Modifier 33 (preventive service) October 2016
Dialysis Providers Policy Update for Some Chronic Dialysis Local Codes (Z6000-Z6052)  October 2016 
DME Providers  Policy Update for Fixed Height Hospital Beds  October 2016
 DME Providers Policy Update for Cough Stimulating Device Supplies (HCPCS Codes A7020, A7027-A7045 & E0482) October 2016
 ALL PROVIDERS 2016 CPT-4/HCPCS Annual Update September 2016
 Physicians and PCPs New End of Life Option Act (ELOA) Services September 2016
ALL PROVIDERS  2017 ICD-10 Diagnosis Codes Update September 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists  New Benefit:  Arsenic Trioxide 1 mg Injection (HCPCS Code J9017) September 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists 
New Benefit: Tecentriq billable under HCPCS Code J3490 (unclassified drugs) September 2016
Physicians, Outpatient Hospitals and Clinics New Benefit: Colorectal Cancer Screening (HCPCS Code G0464) September 2016
Physicians, Outpatient Hospitals, Clinics and Radiologists New Benefit: Coronary Computed Tomography Angiography (CCTA) and Coronary Magentic Resonance Imaging (CMRI)  (CPT-4 Codes 75565, 75571-75574)   September 2016
Physicians, Outpatient Hospitals and Clinics  New Benefit: Reslizumab billable under HCPCS Code J3590 (unclassified biologics)  September 2016
Physicians, Outpatient Hospitals and Clinics  New Benefit: Mepolizumab billable under HCPCS Code J3590 (unclassified biologics)   September 2016 
Physicians, Outpatient Hospitals, Clinics and Laboratories  Policy Update for Oncoprotein Quantitative Test (CPT-4 Code 83951) September 2016
Physicians, Outpatient Hospitals and Clinics    Policy Clarification for Spinal Neurostimulators (CPT-4 Codes 95970-95972) September 2016 
Physicians, Outpatient Hospitals, Clinics and Laboratories   Policy Update for Molecular Pathology Level 8 (CPT-4 Code 81407)  September 2016 
Physicians, Outpatient Hospitals, Clinics and Laboratories   Diagnosis Update for Cardiac Implantable Devices and Stents  September 2016
Acupuncturists  Acupuncture Benefits Restored August 2016
Speech Therapists TAR Requirement Update for Speech Therapy Services  August 2016
DME Providers Clarification for DME Rental Reimbursement Cap August 2016
DME Providers  Clarification for Medical Supply Claims Invoice Requirements August 2016 
Physicians, Outpatient Hospitals and Clinics
Policy Update for Intranasal Influenza Virus Vaccine  August 2016
Physicians, Outpatient Hospitals and Clinics
Policy Update for Medical Abortion Drugs August 2016
Physicians, Outpatient Hospitals and Clinics
New Benefit: Smoking and Tobacco Cessation Counseling (CPT-4 codes 99406 and 99407) July 2016
Physicians, Outpatient Hospitals and Clinics
Clarification: Home Health Per Visit Allowance July 2016
Physicians, Outpatient Hospitals and Clinics
Billing Update for Pregnancy-Related Services (CPT-4 codes 59025,76801,76816, & 76825-76828) July 2016 
Psychological Services  
Billing Update for CMS-1500 claim form  July 2016
Physicians, Outpatient Hospitals and Clinics
Billing Update for Abduction Bar Orthotic Code (HCPCS code L2300) July 2016 
Physicians, Outpatient Hospitals and Clinics
New Benefit: Influenza Treatment Drug Peramivir (HCPCS code J2547)  June 2016
Physicians, Outpatient Hospitals and Clinics  New Benefit: Percutaneous Coronary Intervention (HCPCS code C9460) June 2016 
DME Providers
New Benefit: Hypertension (HCPCS code A4670) June 2016
Physicians, Outpatient Hospitals and Clinics 
New Benefit: Allergen Immunotherapy Services (CPT-4 codes 95144 and 95170)

June 2016
Physicians, Outpatient Hospitals and Clinics 
New Benefit: Filgrastim-sndz (HCPCS code Q5101) June 2016
Physicians, Outpatient Hospitals and Clinics 
Policy Update for Molecular Pathology (CPT-4 codes 81161 and 81408) June 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists
Policy Update for Lynch Syndrome Genetic Testing (CPT-4 codes 81294, 81297, 81300, 81319, & 81403) June 2016
Physicians, Outpatient Hospitals and Clinics 
Policy Update for Meningococcal Serogroup B Vaccine (CPT-4 codes 90620-90621) June 2016 
Physicians, Outpatient Hospitals, Clinics and Obstetricians  Policy Update for Pregnancy-Related Services (Local code Z1038) June 2016
Physicians, Outpatient Hospitals and Clinics 
Billing Update for CRNAs Billing Codes (CPT-4 codes 62267-62273,62280-62287,62290-62297,62310,62311,62318,62319,64400-64439, & 64444-64530) June 2016
Physicians, Outpatient Hospitals and Clinics 
Billing Update for Anesthesia Services (CPT-4 code 62318) June 2016 
Physicians, Outpatient Hospitals, and Clinics 
Billing Update for Naloxone Hydrochloride (HCPCS code J2310) June 2016
Physicians, Outpatient Hospitals and Clinics    Rate Update for Electrocardiogram Procedures (CPT-4 Codes 93000,93005, & 93010) May 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists  Policy Update for Gene Expression Profiling for Breast Cancer (CPT-4 Codes 81519 & 81599) May 2016
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Bariatric Surgery May 2016
Physicians, Inpatient Hospitals, Outpatient Hospitals and Clinics  
Policy Update for Liver-Lung and Liver-Heart Transplant  May 2016 
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Static Short Arm Splints (CPT-4 code 29125) May 2016 
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Sterilization Procedures (CPT-4 Codes 58661,58700 & 58720)
  
May 2016
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Hormone Injection Therapy  May 2016
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Carfilzomib 1mg Injection (HCPCS Code J9047) May 2016
Physicians, Outpatient Hospitals and Clinics  
Billing Update for Nivolumab 1mg Injection (HCPCS Code J9299) May 2016
Physicians, Outpatient Hospitals and Clinics  
Billing Update for Pathology for HCPCS and CPT-4 Codes  May 2016
Physicians, Outpatient Hospitals and Clinics  
New Benefit: DSMT HCPCS G0108-G0109 and MNT CPT-4 codes 97802-97804 May 2016
Physicians, Outpatient Hospitals, and Clinics New Benefit: Radiopharmaceutical Diagnostic Imaging billable under HCPCS code C9461 May 2016
Physicians, Outpatient Hospitals, and Clinics  New Benefit: Genectic testing for maturity onset diabetes (CPT-4 codes 81404-81406) May 2016
Hospice Providers Billing Update: HIPPA Compliant Code Conversion Updates
May 2016
Hospice Providers Billing Update: HIPPA Compliant Code Conversion Updates
April 2016
Home Health Providers Billing Update: HIPPA Compliant Code Conversion Updates
April 2016
Medical Transportation Providers Billing Update: HIPPA Compliant Code Conversion Updates April 2016
Physicians, Outpatient Hospitals and Clinics  
Policy Update for Dispensing Fee April 2016
ALL PROVIDERS 
CMS 1500 Claim Form Update for Rendering Provider Id Number April 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists  New Benefit: Necitumumab Billable Under HCPCS Code J3590 (Unclassified Biologics) March 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists
Policy Update for Pembrolizumab 1 mg Injection (HCPCS Code C9027) March 2016
Physicians, Outpatient Hospitals, Clinics and Oncologists Policy Update for Ipilimumab 1 mg Injection (HCPCS Code J9228)  March 2016
Physicians, Outpatient Hospitals and Clinics   Policy Update for Doxorubicin Hydrochloride Liposome  (HCPCS code J9002) March 2016
 
Physicians, Outpatient Hospitals, Clinics and Obstetricians Policy Update for BRCA 1, BRCA 2 Gene Analysis (CPT-4 Codes 81211 & 81213) March 2016
 
Podiatrists Policy Update for MRI Codes (CPT-4 Codes 73718-73723) March 2016
 
Physicians, Outpatient Hospitals and Clinics   Rate Update for Epix and Theraskin Codes (HCPCS Codes Q4121 and Q4131)  March 2016
 
Physicians, Outpatient Hospitals and Clinics    Rate Update for Modifier UA and UB (modifiers for surgical and anesthesia-related supplies and drugs)   March 2016
 
 ALL PROVIDERS Billing for Dual Eligible Members February 2016
Physicians, Outpatient Hospitals and Clinics Policy Update for Polysomnography Codes (CPT-4 Codes 95782, 95783, 95810 & 95811) February 2016
Physicians, Outpatient Hospitals and Clinics
Policy Reminder for Intraoperative Neurophysiology Monitoring (CPT-4 Codes 95940 & 95941)  February 2016
Physicians, Outpatient Hospitals and Clinics  Policy Update for Extracorporeal Membrane Oxygenation (ECMO) and Extra Corporeal Life Support (ECLS)  February 2016
Physicians, Outpatient Hospitals and Clinics
Policy Update for Filgrastim [G-CSF], Biosimilar, 1 mcg Injection (HCPCS Code Q5101)  February 2016
Physicians, Outpatient Hospitals and Clinics  Rate Update for Advance Care Planning Consultations (CPT-4 Codes 99497 & 99498) February 2016
DME, Orthotics & Prosthetics Providers  Policy Update for Protective Helmet Codes (HCPCS Codes A8000-A8004) February 2016
Physicians, Outpatient Hospitals and Clinics  Policy Update for Biochemical Assays (CPT-4 Codes 81500 & 81503) February 2016
Physicians, Outpatient Hospitals and Clinics   Policy Update for Aflibercept 1 mg Injection (HCPCS Code J0178) February 2016
Physicians, Outpatient Hospitals and Clinics   Policy Update for Nivolumab 1 mg Injections (HCPCS Code C9453) February 2016 
Obstetricians, Physicians, Outpatient Hospitals and Clinics  
 
Policy Update for Antepartum Fetal Testing (CPT-4 Code 59025) February 2016 
 Chiropractors  Diagnosis Code Update for Chiropractic Services (CPT-4 Codes 98940-98942)  February 2016
ALL PROVIDERS  Billing Update:  External Cause of Morbidity Diagnosis Codes January 2016
Obstetricians  Policy Update for Antepartum Visits and Global Obstetrical Billing January 2016
Physicians, Outpatient Hospitals and Clinics  New Benefit:  Sulfur Hexafluoride Lipid Microsphere, per ml (HCPCS code C9457)  January 2016
 
Physicians, Outpatient Hospitals, Clinics, Obstetricians, Gynecologists and Laboratories 
Policy Update for Human Papillomavirus (HPV) Testing (CPT-4 Codes 87624 & 87625)  January 2016
 
Physicians, Outpatient Hospitals, Clinics and Laboratories
 
Policy Update for BRAF Gene Analysis (CPT-4 Code 81210)  January 2016
 
Physicians, Outpatient Hospitals, Clinics and Laboratories  Policy Update for Molecular Pathology Procedure, Level 6 (CPT-4 81405)  January 2016
 
Physicians, Outpatient Hospitals, Clinics and Laboratories   Policy Update for Cytopathology, Cervical or Vaginal Slides (CPT-4 88164-88167)  January 2016
 
DME Providers Policy Update for Bi-PAP and CPAP Equipment  January 2016
 
DME Providers Policy Update for Electrical Stimulation Device (HCPCS Code E0766)  January 2016 

ARCHIVE - 2015 Recent Billing/Policy Update Articles

Here you will find previously posted 2015 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2015 Recent Billing/Policy Update Articles Original Posting Date
Physicians, Outpatient Hospitals and Clinics
Policy Update for Brentuximab Vedotin 1 mg Injection (HCPCS Code J9042)  December 2015
Physicians, Outpatient Hospitals and Clinics
Policy Update for Meningitis Vaccines (CPT-4 Code 90734) December 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Albumin Infusions (HCPCS Codes P9041, P9045, P9046 and P9047) December 2015
Physicians, Outpatient Hospitals and Clinics
Policy Update for Streptococcus Amplified Probe Technique (CPT-4 Code 87651) December 2015
Physicians, Outpatient Hospitals and Clinics
Policy Update for Total Disc Arthroplasty (CPT-4 Codes 22856 and 22858)  December 2015
Psychologists
Place of Service Clarification for Psychology Services December 2015
Physicians, Outpatient Hospitals and Clinics  ICD-10 Diagnosis Code Updates for Hyperbaric Oxygen Therapy  December 2015
Hospice Providers, Physicians, Outpatient Hospitals and Clinics  Clarification of Hospice Face-to-Face Recertification December 2015
ALL PROVIDERS  Policy Update for Medi-Cal Crossover Codes December 2015
Oncologists, Physicians, Outpatient Hospitals and Clinics New Benefit: Blinatumomab 1 mcg Injection (HCPCS Code C9449) November 2015
Ophthamologists, Physicians, Outpatient Hospitals and Clinics  New Benefit: Fluocinolone Acentonide Intravitreal Implant (HCPCS Code C9450) November 2015
Physicians, Obstetricians, Outpatient Hospitals and Clinics New Benefit: Nivolumab 1 mg Injection (HCPCS Code C9453) November 2015
Physicians, Outpatient Hospitals and Clinics
 New Benefit:  Ziv-Aflibercept 1 mg Injection (HCPCS Code J9400) 
November 2015 
Physicians, Outpatient Hospitals and Clinics
New Benefit:  Intensive Behaviorial Therapy for Obesity (HCPCS Code G0473 and G0447) November 2015 
Family Planning Providers, Physicians, Outpatient Hospitals and Clinics  New Benefit:  Onsite Dispensing of Contraceptive Vaginal Ring (HCPCS Code J7303) and Transdermal Patch (HCPCS Code J7304) November 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Transprostatic Implants (CPT-4 Code 52442) November 2015
Physicians, Outpatient Hospitals and Clinics  Clarification of Modifier QW for CLIA-Waived Codes  November 2015
DME Providers  Policy Clarification for Wheelchair Accessories (HCPCS Codes E1010 and K0108) November 2015
ALL PROVIDERS ICD-10 Update:  New Explain Codes October 2015
Family Planning Providers Policy Update for Liletta, HCPCS Codes J7302 (Levonorgestrel-Releasing Intrauterine Contraceptive System), 52 mg October 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Cystourethroscopy (HCPCS Codes C9739 and C9740) October 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Alemtuzumab 1 mg Injection (HCPCS Code Q9979) October 2015
DME, Orthotics and Prosthetics Providers  Policy Update for HCPCS Code A7048 (Vacuum Drainage Collection Unit and Tubing Kit, Each) October 2015 
Physicians, Outpatient Hospitals, Clinics and Laboratories  Policy Update for Genetic Testing of Gliomas (CPT-4 Codes 81402, 81403 and 81479) October 2015
DME, Orthotics and Prosthetics Providers Policy Update for HCPCS Code E0445 (Oximeter Device for Measuring Blood Oxygen Levels Non-Invasively) October 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Carfilzomib 1 mg Injection (HCPCS Code J9047) October 2015
Physicians, Outpatient Hospitals, Clinics and Laboratories Policy Update for Molecular Pathology Codes 81250, 81287, 81404 and 81405 October 2015
Physicians, Outpatient Hospitals and Clinics  Policy Update for Corticorelin Ovine Triflutate 1 mcg Injection (HCPCS Code J0795) October 2015
Physicians, Outpatient Hospitals and Clinics Diagnosis Update for Zoledronic Acid 1 mg Injection (HCPCS Code J3489) October 2015
Physicians, Outpatient Hospitals and Clinics Diagnosis Update for Injection Codes C9254, J0740 and J0775 October 2015
Physicians, Outpatient Hospital and Clinics  Diagnosis Update for Goserelin Acetate 3.6 mg Implant (HCPCS code J9202) October 2015
Oncologists  Diagnosis Update for Chemotherapy Codes J1300, J9178, J9185 and J9390 October 2015
 ALL PROVIDERS ICD-10 Update:  DHCS' Provider Manual Replacement Pages Posted September 2015
ALL PROVIDERS  2015 CPT-4/HCPCS Annual Update:  DHCS' Provider Manual Replacement Pages Posted September 2015
DME Providers  DME Wheelchair Coverage Criteria Update September 2015
DME Providers  New Benefit:  Manual Wheelchair Accessory September 2015
Physicians, Outpatient Hospitals, Clinics and Laboratories  Policy Update for HCPCS Code G6040 (Alcohol [Ethanol]; Any Specimen Except Breath September 2015
Physicians, Outpatient Hospital and Clinics  Policy Update for Denosumab 1 mg Injection (HCPCS Code J0897) September 2015
Physicians, Outpatient Hospital and Clinics   Rate Update for Speech Evaluation Codes (CPT-4 Codes 92521-92524)  September 2015
Physicians, Outpatient Hospital and Clinics    Diagnosis Update for CPT-4 Code 87389 (HIV-1 Antigen)  September 2015
Physicians, Outpatient Hospitals, Clinics and Laboratories   Billing Update for HCPCS Code S3854 (Gene Expression Profiling Panel for Use in Management of Breast Cancer Treatment  September 2015
Physicians, Outpatient Hospital and Clinics     Billing Clarification:  Aqueous Shunt (CPT-4 Code 66183)  September 2015
Physicians, Outpatient Hospital and Clinics    
Policy Update for CPT-4 Code 36515 (Therapeutic Apheresis, w/Extracorporeal Immunoadsorption and Plasma Reinfusion  September 2015
 ALL PROVIDERS ICD-10 Update August 2015
ALL PROVIDERS  2015 CPT-4/HCPCS Annual Update:  Policy Updates August 2015
ALL PROVIDERS  Policy Update:  Management of Chronic Hepatitis C August 2015
ALL PROVIDERS  Policy Update for Dynamic Adjustable Knee Extension (HCPCS Code E1810) August 2015
Physicians, Outpatient Hospitals and Clinics  New Benefit:  Meningococcal B Vaccines (CPT-4 Codes 90620 & 90621) July 2015
Anesthesiologists  Two New Anesthesia Modifiers - AA and QY July 2015
Physicians, Outpatient Hospitals, Clinics and Oncologists  Policy Update for Various Chemotherapy Codes (HCPCS codes J0894, J9000, J9025, J9045, J9171) July 2015
Physicians, Outpatient Hospitals, Clinics and Ophthalmologists  Policy Update for Bevacizumab 10 mg Injection (HCPCS code J9035) July 2015
Physicians, Outpatient Hospitals and Clinics   Policy Update for "Manipulation Chest Wall" Codes (CPT-4 codes 94667 and 94668) July 2015
DME, Orthotics and Prosthetics Providers Policy Update for Dynamic Adjustable Knee Extension (HCPCS Code E1810) July 2015
Physicians, Outpatient Hospitals, Clinics and Laboratories Rate Change for Laboratory and Pathology Services  June 2015
Physicians, Outpatient Hospitals, Clinics and Oncologists
New Benefit:  Nivolumab (IgG4 Monoclonal Antibody) Under HCPCS Code J3590 (Unclassified Biologics) June 2015
Physicians, Outpatient Hospitals, Clinics and Oncologists  New Benefit:  Pembrolizumab 1 mg Injection (HCPCS Codes C9027) June 2015
Physicians, Outpatient Hospitals, Clinics and Radiologists 
 Policy Update for Low Dose Computed Tomography (HCPCS Code S8032)
June 2015
Physicians, Outpatient Hospitals, Clinics and Ambulatory Surgical Centers
Policy Update for Dental Services Billable Under CPT-4 Code 41899 June 2015
Physicians, Outpatient Hospitals, and Clinics  Policy Update for Intravenous Sedation and General Anesthesia Guidelines for Dental Procedures June 2015
Physicians, Outpatient Hospitals, and Clinics 
Policy Update for Quantitative or Semiquantitative Allergen Testing (CPT-4 86003) June 2015
Physicians, Outpatient Hospitals, Clinics and Laboratories 
Policy Update for CPT-4 Codes 86780 (Teponema Palladium) and 87502 (Influenza Virus) June 2015
Physicians, Outpatient Hospitals, and Clinics   Diagnosis Update for Dexamethasone Intravitreal Implant (HCPCS Code J7312) June 2015
Physicians, Outpatient Hospitals, and Clinics 
Diagnosis Update for HLA Class I Typing, High Resolution, One Allele or Allele Group (CPT-4 Code 81381) June 2015
Physicians, Outpatient Hospitals, and Clinics  Diagnosis Update for Leuprolide Acetate Injections (HCPCS Codes J1950 and J9217) June 2015
Physicians, Outpatient Hospitals, and Clinics   Diagnosis Update for Fluocinolone Acetonide (HCPCS Code J7311) June 2015
 Vision Providers Diagnosis Update for Specific Vision Care Service Codes June 2015
DME, Orthotics and Prosthetics Providers  Updated Frequency Limits for DME, Orthotics and Prosthetics Codes June 2015
Physicians, Outpatient Hospitals, Clinics, Laboratories and Radiologists  Modifier ZS to be Discontinued  May 2015 
ALL PROVIDERS  ICD-10 Important Reminder April 2015
ALL PROVIDERS  2015 CPT-4/HCPCS Annual Update April 2015
ALL PROVIDERS Contacting CenCal Health for Claims Inquiries April 2015
Physicians, Outpatient Hospitals and Clinics Policy Update for Dalbavancin 10 mg Injection (HCPCS Code C9443) April 2015
Physicians, Outpatient Hospitals and Clinics
ICD-9-CM Codes Eliminated (68.3, 68.5, & V39.21)  April 2015
Physicians, Outpatient Hospitals and Clinics  New Benefit:  Health and Behavior Assessment/Intervention Services (CPT-4 Codes 96150-96154)  April 2015
Physicians, Outpatient Hospitals and Clinics  New Benefit:  Ramucirumab 5 mg Injection (HCPCS Code C9025)  April 2015
Medical Transportation Providers Medical Transportation Code Conversion March 2015
Physicians, Outpatient Hospitals and Clinics 
Billing Medroxyprogesterone Acetate Injection for Contraceptive Use (HCPCS Code J3490 with Modifier U8) March 2015
Physicians, Outpatient Hospitals and Clinics   REMINDER - New NCCI-Associated Modifiers (XE, XP, XS, XU)  March 2015
Physicians, Outpatient Hospitals and Clinics 
Policy Update for Bevacizumab 10 mg Injection (HCPCS Code J9035) March 2015
Physicians, Outpatient Hospitals and Clinics   Policy Update for Azacitidine 1 mg Injection (HCPCS Code J9025) March 2015
Obstetricians, Physicians, Outpatient Hospitals and Clinics  Policy Revised for Fetal Monitoring During Labor (CPT-4 Codes 59050 and 59051) March 2015
Family Planning Providers  Medi-Cal Rate Increase for CPT-4 Codes 11981 and 58300 March 2015
Physicians, Outpatient Hospitals, Clinics, Laboratories  TAR Requirement for All Tier 2. Molecular Pathology Procedure Codes (CPT-4 Codes 81400-81408) March 2015
 DME Providers Tax Status Update for DME, Orthotic and Prosthetic Codes March 2015
 ALL PROVIDERS New Claim Correction Process February 2015
ALL PROVIDERS  Frequently Asked Questions for New Claim Correction Process February 2015
Physicians, Outpatient Hospitals and Clinics New Benefit:  Octreotide Injections (HCPCS Codes J2353 and J2354) February 2015
Physicians, Outpatient Hospitals and Clinics  New Benefit: Behaviorial Therapy for Cardiovascular Disease (HCPCS Code G0446)  February 2015
DME Providers  New Benefit:  Bulking Agents for Treating Urinary Incontinence (HCPCS Code L8603 and L8606) February 2015 
Physicians, Outpatient Hospitals, Clinics and Laboratories  Policy Update for Molecular Pathology Procedure, Level 3 (CPT-4 code 81402) February 2015
Physicians, Outpatient Hospitals and Clinics   Policy Update for Denosumab 1 mg Injection (HCPCS Code J0897) February 2015
Hospice Providers  Policy Update for Hospice Care Face-to-Face Encounters February 2015
DME Providers  Rate Change for Specific DME Codes February 2015
Physicians and Outpatient Hospitals  HIPAA Conversion and Billing Update for Organ Procurement Codes February 2015
Physicians, Outpatient Hospitals and Clinics   New Benefit: 4 New NCCI Modifiers (XE, XP, XS and XU)  January 2015
DME Providers  New Benefit: Breast Pump Supplies (HCPCS Codes A4281-A4286) January 2015
Physicians and Dialysis Clinics Policy Update:  Hepatitis B Tests Now Available for Dialysis Patients January 2015
Physicians, Outpatient Hospitals and Clinics   Policy Update for Noninvasive Prenatal Testing for Fetal Aneuploidy January 2015
ALL PROVIDERS  2015 EOB Check Dates January 2015

ARCHIVE - 2014 Recent Billing/Policy Update Articles

Here you will find previously posted 2014 articles from the "Recent Billing/Policy Updates" section


Attention ARCHIVED 2014 Recent Billing/Policy Update Articles Original Posting Date
ALL PROVIDERS Notification of 2015 CPT-4/HCPCS Codes December 2014
Physicians, Outpatient Hospitals and Clinics New Benefit: Low-Dose Computer Tomography for Lung Cancer Screening (HCPCS Code S8032) December 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update for Specific Surgery Codes  December 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update for Meningococcal Vaccine Benefit (HCPCS Code 90644) December 2014
Oncologists Policy Update for Breast Cancer Gene Expression Profiling (HCPCS Code S3854) December 2014
Hospice Providers Policy Update for Hospice Care Eligibility Requirements December 2014
Allergists, Laboratories, Outpatient Hospitals and Clinics  Policy Update for Allergen Specific IgE (CPT-4 Code 86003) December 2014
Ophthalmologists  Policy Update for Intravitreal Dexamethasone (HCPCS Code J7312) December 2014
Physicians, Outpatient Hospitals, Clinics and Laboratories Policy Update for Infectious Agent Detection (CPT-4 Code 87798) December 2014
Physicians, Outpatient Hospitals and Clinics   Policy Update for Two Vaccines that are No Longer Being Manufactured (CPT-4 Codes 90705 and 90706) December 2014
ALL PROVIDERS Introducing 2 New Claims Department Customer Service Representatives November 2014
Physicians, Outpatient Hospitals and Clinics   New Benefit: Signal-Averaged Electrocardiography [SAECG], with or without ECG (CPT-4 Code 93278) November 2014
Physicians, Outpatient Hospitals and Clinics   New Benefit: Vedolizumab 1 mg Injection (HCPCS Code C9026) November 2014
Orthotics and Prosthetics Providers  New Benefit: Single and Double Knee Orthoses (HCPCS Codes K0901 and K0902) November 2014
Physicians, Outpatient Hospitals and Clinics    Policy Update for Mitroxantrone HCI, per 5 mg Injection (HCPCS Code J9293) November 2014
Physicians, Outpatient Hospitals and Clinics   Policy Update for Neonatal Hypothermia (CPT-4 Codes 99481 and 99482) November 2014
Physicians, Outpatient Hospitals and Clinics    Policy Update for Transluminal Balloon Angioplasty (CPT-4 Codes 75962) November 2014
DME Providers  Reminder: Authorization and Billing Limit Requirements November 2014
Physicians, Outpatient Hospitals and Clinics     Rate Reduction for Electrocardiograms (CPT-4 Codes 93000, 93005 and 93010) November 2014
ALL PROVIDERS  ICD-10 Transition Checklist Available October 2014
LTC FS/NF-B Providers  Interim Rates Established October 2014
Physicians, Outpatient Hospitals and Clinics      New Benefit:  HCPCS Codes S0144 (Propofol 10 mg Injection) and Q9974 (Morphine Sulfate 10 mg Injection) October 2014
Physicians, Outpatient Hospitals and Clinics       New Benefit: Brachytherapy (HCPCS Code C2644) October 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update for Bevacizumab 10 mg Injection (HCPCS Code J9035) October 2014
Physicians, Outpatient Hospitals and Clinics
Policy Update for Amifostine 500 mg Injection (HCPCS Code J0207) October 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update for Epirubicin HCI 2 mg Injection HCPCS Code J9178) October 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update for Lumizyme 10 mg Injection (HCPCS Code J0221) October 2014
Physicians, Outpatient Hospitals and Clinics   Policy Update for Aflibercept 1 mg Injection (HCPCS Code J0178) October 2014
Physicians, Outpatient Hospitals and Clinics   Frequency Limit Update for CPT-4 Codes 81507 and 81287 and 'Do Not Report' Update for HCPCS Codes G0461 and G0462 October 2014
ALL PROVIDERS  IMPORTANT REMINDER September 2014
Physicians, Outpatient Hospitals and Clinics  New Benefit: Dalbavancin, Billable under HCPCS Code J3490 (unclassified drugs) September 2014
Physicians, Outpatient Hospitals and Clinics   Policy Update for Dexamethasone Intravitreal Implant (HCPCS Code J7312) September 2014 
 Laboratories Policy Update for Tier 2 Molecular Pathology Procedure (CPT-4 Code 81400) September 2014 
ALL PROVIDERS  ICD-10 Update August 2014 
ALL PROVIDERS  CMS 1500 Update August 2014 
ALL PROVIDERS  2014 CPT-4/HCPCS Annual Update:  TAR and ICD-9-CM Codes August 2014 
Physicians, Outpatient Hospitals and Clinics   New Benefit: Vedolizumab, Billable under HCPCS Code J3590 (unclassified biologics) August 2014 
 Surgeons Policy Update for Surgery Reimbursement August 2014 
Laboratories  Policy Update for Tissue Culture (CPT-4 Codes 88230 and 88235) August 2014 
Obstetricians  Clarification of "Pregnancy Related" Term August 2014 
Hospice Providers  Clarification of Appropriate Diagnoses for Hospice Claims August 2014 
Physicians and Outpatient Hospitals Hyperbaric Oxygen Therapy (HBO):  Change to Billing and TAR Requirements  August 2014 
ALL PROVIDERS  2014 CPT-4/HCPCS Codes: Additional Information  July 2014
ALL PROVIDERS  CMS 1500 Billing Update July 2014 
Physicians, Outpatient Hospitals and Clinics    New Benefit:  Cystourethroscopy (HCPCS Codes C9739 and C9740) July 2014 
PCPs  New Benefit: Meningococcal Conjugate Vaccine (CPT-4 Code 90644) July 2014 
Physicians, Outpatient Hospitals and Clinics  New Benefit: Obinutuzumab (HCPCS Code C9021) July 2014 
Family Planning Providers  Policy Update for Contraceptive Supply, Condoms (HCPCS Codes A4267 and A4268) July 2014 
Family Planning Providers  Policy Update for RN Dispensing and Administration of Hormonal Contraceptives July 2014 
Physicians, Outpatient Hospitals and Clinics   Diagnosis Update for Sargramostim [GM-CSF] 50 mg Injection (HCPCS Code J2820) July 2014 
PCPs and Obstetricians  Policy Update for CPT-4 Code 90715 (TDaP Vaccine) July 2014 
Radiology Providers  Policy Reminder for Positron Emission Tomography (PET) Scans July 2014 
Orthotics and Prosthetics Providers Definition of Custom-Fabricated Orthotics July 2014 
DME, Orthotics and Prosthetics Providers  Policy Clarification for Shipping and Handling of DME, Orthotics and Prosthetics July 2014
Laboratory and Pathology Providers  Delayed: Discontinuation of Split Billing for Specific Laboratory and Pathology Codes June 2014 
Physicians  New Benefit:  Tbo-Filigrastim 5 mcg Injection (HCPCS Code J1446) June 2014 
Physicians, Outpatient Hospitals and Clinics  Diagnosis Update:  Bendamustine HCL 1 mg Injection (HCPCS Code J9033) June 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update:  Ecallantide (HCPCS Code J1290) June 2014 
DME Providers  Policy Clarification for DME Date of Service June 2014 
PCPs  Policy Update for Meningococcal Vaccine (HCPCS Code 90644) May 2014 
ALL PROVIDERS  Policy Information for 2014 CPT-4/HCPCS Annual Update May 2014 
Oncologists  Policy Update for Gemcitabine HCI 200 mg (HCPCS Code J9201) and Ifosfamide 1 gm Injection (HCPCS Code J9208) May 2014
PCPs  Policy Update for Influenza Vaccines (HCPCS Codes 90672, 90685, 90686 and 90688) May 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update for Omalizumab 5 mg Injection (HCPCS Code J2357) May 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update for Paclitaxel 30 mg Injection (HCPCS Code J9310) May 2014 
Physicians, Outpatient Hospitals and Clinics   Policy Update for Ziprasidone Mesylate 10 mg Injection (HCPCS J3486) May 2014 
DME, Orthotics and Prosthetics Providers  Policy Update for "By Report" Orthotics and Prosthetics Pricing  May 2014
Physicians, Outpatient Hospitals and Clinics   Diagnosis Update for Pemetrexed 10 mg Injection (HCPCS Code J9035)  May 2014 
Physicians, Outpatient Hospitals and Clinics    Diagnosis Update for Rituximab 100 mg Injection (HCPCS Code J9310) May 2014 
Physicians, Outpatient Hospitals and Clinics 
Diagnosis Update for Topotecan 0.1 mg Injection (HCPCS Code J9351)  May 2014 
Physicians, Outpatient Hospitals and Clinics  Diagnosis Update for Verteprofin 0.1 mg Injection (HCPCS Code J3396) May 2014 
Physicians, Outpatient Hospitals and Clinics   Diagnosis Update for Vitamin B-12 Cyanocobalamin, up to 1000 mg Injection (HCPCS Code J3420) May 2014 
DME Providers  HCPCS Code K0900 - No Longer Medi-Cal Benefit May 2014
Laboratory and Pathology Providers Discontinuation of Split Billing for Specific Laboratory and Pathology Codes May 2014 
ALL PROVIDERS  ICD-10 Implementation Delayed April 2014
Physicians, Outpatient Hospitals and Clinics
Diagnosis Update: Aldesleukin Injection (HCPCS Code J9015) April 2014 
Physicians, Outpatient Hospitals and Clinics
New Benefit: Loxapine Inhalation Powder (HCPCS Code C9497) April 2014
PCPs  New Benefit: Meningococcal Vaccine (HCPCS Code 90644) April 2014 
Physicians, Outpatient Hospitals and Clinics
New Benefit: Ocriplasmin 0.125 mg Injection (HCPCS Codes J7316/C9298) April 2014 
Physicians, Outpatient Hospitals and Clinics
New Benefit: Aripiprazole Extended Release (HCPCS Code J0401) April 2014 
Physicians, Outpatient Hospitals and Clinics
Policy Update:  Ado-Trastuzumab Emtansine 1 mg Injection (HCPCS Codes J9354/C9131) April 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update: Carfilzomib 1 mg Injection (HCPCS Codes J9047/C9295) April 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update: Taliglucerase Alfa 10 units Injection (HCPCS Codes J3090/C9294) April 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update: Non-Benefit - Sermorelin Acetate 1 mcg Injection (HCPCS Code Q0515) April 2014 
Physicians, Outpatient Hospitals and Clinics 
Policy Update: Tositumomab Discontinued (HCPCS Codes G3001, A9544 and A9545) April 2014 
Physicians, Outpatient Hospitals and Clinics   Rate Update:  Apheresis Services (HCPCS Codes 36511-36516, 38205 and 38206) April 2014
ALL PROVIDERS  ICD-10 Update: Preparation Tools and Tips March 2014 
Oncologists  New Benefit: Vincristine Sulfate Liposome Injection (HCPCS Code J9371) March 2014 
Oncologists  New Benefit: Pertuzumab 1 mg Injection (HCPCS Code J9306) March 2014 
Rheumatologists  New Benefit: Certolizumab Pegol 1 mg Injection (HCPCS Code J0717) March 2014 
Physicians, Outpatient Hospitals and Clinics  New Benefit: Adenosine Injection (HCPCS Code J0151) March 2014 
Physicians, Outpatient Hospitals and Clinics  New Benefit: Bivigam Injection, Immune Globulin 500 mg (HCPCS Code J1556) March 2014 
Physicians, Outpatient Hospitals and Clinics   New Benefit: Golimumab 1 mg Injection (HCPCS Code J1602) March 2014 
Physicians, Outpatient Hospitals and Clinics   New Benefit: Zoledronic Acid 1 mg Injection (HCPCS Code J3489) March 2014 
Audiologists  Policy Update:  Hearing Aid Reimbursement Rates March 2014 
DME Providers  Policy Update:  TAR Documentation for Apnea Monitors (HCPCS Codes E0618 and E0619) March 2014
Physicians, Outpatient Hospitals and Clinics  Policy Update: Diagnosis Restrictions for Tumor Antigens (CPT-4 Code 86304) March 2014 
Physicians, Outpatient Hospitals and Clinics  Policy Update: Patient Age Restrictions for Tuberculosis Tests (CPT-4 Codes 86480 and 86481) March 2014 
Physicians, Outpatient Hospitals and Clinics   Policy Update: Invoice No Longer Required for Low Osmolar Contrast Material (HCPCS Codes Q9965-Q9967) March 2014 
ALL PROVIDERS  New Fax # for the Claims Department February 2014 
 
Physicians and Psychologists  New Benefit: Screening, Brief Intervention and Referral to Treatment for Alcohol Misuse (HCPCS H0049 and H0050) February 2014 
 
PCPs  New Benefit: Flublok RIV3 (CPT-4 90673) February 2014 
 
Inpatient Hospitals  Benefit Expansion: Voluntary Inpatient Detoxification February 2014 
 
Physicians, Outpatient Hospitals and Clinics  New Emergency Contraceptive Benefit: Ulipristal Acetate (Ella 30 mg) Billable under J3490 U5 February 2014 
Physicians, Outpatient Hospitals and Clinics   New Benefit: Filgrastim [G-CSF] 1 mcg Injection (HCPCS Code J1442) February 2014
 
Physicians, Outpatient Hospitals and Clinics   Diagnosis Update for Biochemical Assays (CPT-4 Codes 81508 and 81511) February 2014
 
Physicians, Outpatient Hospitals and Clinics   Policy Update: Quantity of Units Increase for Various Medications February 2014
 
Medical Ground and Air Transportation Providers  Policy Update for Billing "Dry Run" Claims February 2014
 
ALL PROVIDERS  ICD-10: New Claim Form Highlights and New Survey January 2014
 
Physicians, Outpatient Hospitals and Clinics   New Benefit: Ferric Carboxymaltose (HCPCS Code C9441) January 2014
 
Radiology Providers New Benefit: Radium Ra 223 Dichloride (HCPCS Code A9699) January 2014
 
Physicians, Outpatient Hospitals and Clinics   New Benefits and Age Restrictions for Virus Vaccines (HCPCS 90685, 90686 and 90688) January 2014