Provider Update

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

• 2026 HCPCS Quarter 4 Update
• Justice-Involved (JI) Reentry Initiative: New Aid Codes for Members with UIS Coming Soon
• EWC Program Policy Updates: New Covered Procedure Codes and ICD-10-CM Diagnosis Codes
• Reimbursement Rates Updated for Select Radiation Treatment Delivery Codes
• Update to the Medi-Cal List of Contracted Incontinence Creams and Washes
• Billing Policy Clarification for Medi-Cal Enrolled Licensed PTs Who Supervise CHWs
• CPT Code 90616 is a Medi-Cal Benefit
• Family PACT HCPCS Code Rate Update for 2026 Quarter 3
• Required Modifier and Minimum Age Updated for CPT Code 90683
• Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
• Self-Collected Specimen Policy Clarification
• One-Time Timeliness Waiver for LMFT and Psychological Associate Services Delivered by a RHC or FQHC
• Provider Manual Revisions
• Removal of Enhanced FMAP for Emergency Services
• Kaiser Permanente Medi-Cal Health Plan and WCM Expansion in Monterey County
• Updates to Wound Care Medical Supplies and Select HCPCS Codes\Place of Service Code 10 Added for Select CPT Codes
• ICD-10-CM Requirements for FQHC, RHC, IHS-MOA and Tribal FQHC Providers
• Hospital Presumptive Eligibility: New Requirements Coming January 1, 2027
• Reminder Regarding NPIs for Crossover Claims
• Reimbursement Rates for CHW HCPCS Codes G0019 and G0022
• Justice-Involved (JI) Reentry Initiative: Care Management Bundle 5 for Correctional Facilities
• Dialysis Services Coverage Update for Members with Restricted Scope Aid Codes
• New Federal Reimbursement Limitations on Gender Affirming Care for Youth, Effective October 13, 2026
• DRG Payment System Update to Mapper Version 44.0 on October 1, 2026
   

For detailed information regarding these changes, please refer to:

• General Medicine Bulletin 628
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine
• Medi-Cal Program & Eligibility Bulletin 51
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=medi-cal-program-and-eligibility
• Durable Medical Equipment and Medical Supplies Bulletin 613 
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=durable-medical-equipment-and-medical-supplies
• Psychological Services Bulletin 613
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=psychological-services
• Clinics and Hospitals Bulletin 625
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=clinics-and-hospitals
• Inpatient Services Bulletin 625
  https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=inpatient-services
• Medi-Cal News Flashes

             https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34003
              https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33813.29
              https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34256
              https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34227.01
              https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/34182

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.