HIPAA: Code Conversions

We thank you for your continued participation in the Santa Barbara Health Initiative (SBHI) and/or San Luis Obispo Health Initiative (SLOHI) programs, administered by CenCal Health.

The Health Insurance Portability and Accountability Act (HIPAA) mandates the standardization of internal (administrative) code sets and the use of standard service/procedure code sets for transactions. CenCal Health has been working diligently to convert its interim (local) codes to national values.

The code conversion establishes HIPAA-compliant procedure codes for services rendered by replacing the non-HIPAA-compliant codes. The alternative solution includes utilization of revenue codes, CPT codes, HCPCS Level II codes, and modifiers. We are currently working with our Long Term Care and Hospital Providers and will have the conversion information added soon.

Effective for dates of service on and after July 1, 2017, CenCal Health will no longer accept non-HIPAA-compliant codes, with the exception of FQHC codes. The FQHC code conversions will continue as scheduled in the State Medi-Cal website. The FQHC conversion tables can be obtained through the State Medi-Cal website.  

Please note: for State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.


Audiology/EPSDT Audiology/Speech Therapy

Effective for dates of service on and after July 1, 2017

The audiology/speech therapy code conversion provides the strategy for converting HCPCS Level III procedure codes to valid HCPCS Level II national procedure codes for audiology and Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and speech therapy services.  HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for audiology and speech therapy services. 

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for audiology and speech therapy services will be discontinued.  Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members.  All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion. 

Click here to view the provided details and examples.

Please note: for Medi-Cal claims billed to the State, local codes may still be required after July 1, 2017. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

Dialysis

Effective for dates of service on and after July 1, 2017

The dialysis code conversion establishes HIPAA-compliant procedure codes for dialysis services by replacing the non-HIPAA-compliant Z-codes. The alternative solution includes utilization of revenue codes, CPT codes, HCPCS Level II codes, and modifiers. 

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for dialysis services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.The dialysis code conversion establishes HIPAA-compliant procedure codes for dialysis services by replacing the non-HIPAA-compliant Z-codes. The alternative solution includes utilization of revenue codes, CPT codes, HCPCS Level II codes, and modifiers.

Click here  to view the provided details and examples.

Please note: for State Medi-Cal claims, local codes may still be required after July 1. It will be important to monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

EPSDT Services: Supplemental Services

Effective for dates of service on and after July 1, 2017

The Supplemental Services code conversion will replace non-HIPAA-compliant local codes with national HIPAA-compliant HCPCS procedure codes. National codes identified in combination with an EP modifier will allow for the distinction of services rendered to adults from services rendered to persons younger than 19 years of age while also preserving the currently rate for services rendered to children and youths. Children’s Supplemental Services covered by CenCal Health under EPSDT benefits will be uniquely identifiable for the purposes of preserving benefits and rates.

Supplemental Services include private duty nursing services from a Registered Nurse (RN) or a Licensed Vocational Nurse (LVN), case management, pediatric day health care and nutritional and mental health evaluations and services.

Effective for dates of service on and after July 1, 2017, the current non-HIPAA-compliant local codes will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for  State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

Home Health and Hospice Services

Effective for dates of service on and after July 1, 2016

The home health and hospice code conversion provides the conversion strategy for local home health care and hospice procedure codes to national procedure codes. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for the claiming of home health and hospice services.

Effective for dates of service on and after July 1, 2016, the current HCPCS Level III codes for Home Health Agencies (HHA) and hospice care services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Hospital Outpatient Services

Effective for dates of service on and after July 1, 2017

The outpatient services code conversion establishes HIPAA-compliant procedure codes used to reimburse providers for hospital outpatient services such as the use of hospital facilities, hyperbaric oxygen therapy and hotel services. This code conversion also deletes existing local procedure codes and replaces non-HIPAA-compliant Z-codes. The alternative solution includes utilization of revenue codes, CPT and HCPCS Level II codes and modifiers.

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for hospital outpatient services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

Maternal Care Services and CPSP

Effective for dates of service on and after July 1, 2017

The maternal Comprehensive Perinatal Services Program (CPSP) code conversion provides the strategy for converting the CPSP local codes to national procedure codes. HIPAA-compliant HCPCS Level II codes have been identified to reimburse CPSP providers.

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for maternal CPSP services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for  State  Medi-Cal claims , local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

Medical Services Other

Effective for dates of service on and after July 1, 2017

The medical services other code conversion makes the necessary system modifications to ensure the medical services codes are in compliance with HIPAA. The combination establishes HIPAA-compliant procedure codes for medical services and deletes existing local codes.

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for medical services other will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for  State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

NICU/PICU Services

Effective for dates of service on and after July 1, 2017

The neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) code conversion establishes HIPAA-compliant procedure codes by terminating the use of HCPCS Level III service procedure codes. The update references valid HCPCS Level II national procedure codes for bill-intensive, care-unit services for both neonatal and pediatric services.

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for NICU/PICU services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.



Occupational/Physical Therapy Services

Effective for dates of service on and after July 1, 2017

The Occupational and Physical therapy services code conversion provides the strategy for converting HCPCS Level III procedure codes to valid HCPCS Level II national procedure codes for occupational and physical therapy services. HIPAA-compliant HCPCS procedure codes are identified to reimburse providers for audiology and speech therapy services.

Effective for dates of service on and after July 1, 2017, the current HCPCS Level III codes for occupational and physical therapy services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.

Please note: for State Medi-Cal claims, local codes may still be required after July 1. It will be important to separately monitor notifications on the State Medi-Cal website related to the State’s conversion to HIPAA-compliant codes.

Medical Transportation

The Medical Transportation code changes have already been in affect since October 1, 2016

The medical transportation code conversion terminates the following items used for billing medical transportation services: local codes, the current set of 46 non-HIPAA compliant local codes, and one local modifier. The conversion also establishes HIPAA-compliant HCPCS codes and HCPCS modifiers, including HCPCS origin/destination modifiers developed by the Centers for Medicare and Medicaid Services (CMS) exclusively for medical transportation services.

Effective for dates of service on and after October 1, 2016, the current HCPCS Level III codes for medical transportation services will be discontinued. Providers are required to bill CenCal Health using the appropriate revenue codes, CPT codes, HCPCS Level II codes, and modifiers for services rendered to CenCal Health members. All current benefit policies and claim documentation requirements will apply to the national codes.

In an effort to provide clarity to our providers, CenCal Health has removed the previously published crosswalk table and provided additional details as well as examples in regards to the HIPAA code conversion.

Click here to view the provided details and examples.