Provider Update

Provider Update No. 194

Date: September 16, 2026

To: Providers

From: CalOptima Health Provider Network Management

Subject: Procedure Code Updates

Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:

Important Update and Reminder: Clade I and II Mpox Cases Within California
Prostate Cancer Awareness Month Spotlight: California’s Prostate Cancer Treatment Program
Billing Update for HCPCS Code J3392
November 2026 Updates to the Medi-Cal List of Contracted Incontinence Creams and Washes
Reminder: Medi-Cal Providers May Not Charge Members to Complete Forms or Provide Information
Modifier NURB/RBNU Is Required for Replacement Only DME Codes
Updates to the List of Codes Reimbursable for Licensed Midwives
Diagnosis Related Group (DRG) Pricing Resources SFY 2026/27
Reminder: New Requirement for Provider Verification in Telephone Service Center
Provider Dispute Resolutions with Managed Care Plans
Public Fee-For-Service Provider Directory: Action Required
National Correct Coding Initiative Quarterly Update for October 2026
Reminder: Policy Clarifications for Covered Medi-Cal CHW Services
Medi-Cal Hospice Program Attestation Now Available in the Provider Portal
Justice-Involved (JI) Reentry Initiative: New Aid Codes for Members with UIS Coming Soon
Enrollment Deadline Extended for Nexplanon REMS Certification

For detailed information regarding these changes, please refer to:

General Medicine Bulletin 627
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine
Durable Medical Equipment and Medical Supplies Bulletin 612
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=durable-medical-equipment-and-medical-supplies
Obstetrics Bulletin 627
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=obstetrics
Medi-Cal NewsFlashes

https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34051
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34064.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33684
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33750.42
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/31896.19
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33973.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33750.45
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33813.25
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33966.03

To access the updated Physician Administered Drug Prior Authorization List (PAD PA List), please refer to https://www.caloptima.org/en/ForProviders/ClaimsandEligibility/PriorAuthorizations.aspx.

Provider Update

Provider Update No. 194

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