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Provider Update

Provider Update No. 177

Date: April 16, 2025

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:

  • 2025 HCPCS Quarter 2 Update
  • HCPCS Code J1300 Is No Longer a Medi-Cal Benefit
  • April 2025 CCS Service Code Groupings Policy Update
  • Presumptive Eligibility: Best Practices
  • Updated Policy for Billing Codes Used for Community Health Worker Services
  • Policy Update for HCPCS Code J9171
  • New Manual Sections for Dyadic Services
  • Emergency Indicators on CMS Claims
  • Provider Manual Revisions
  • Update to Aid Code 50
  • Updated Policy for HCPCS Codes E0691 and E0694
  • Updated ICD-10 Codes for HCPCS Code E3200
  • Reimbursement for COVID-19 Vaccine Only Administration Visits Will End for FQHC, RHC, IHS-MOA and Tribal FQHC Providers
  • 2025 Rate Increase for Home and Community-Based Services Waivers and Programs
  • 2025 ICF/DD, ICF/DD-H, ICF/DD-N Rate Update
  • Correction to Effective Date for the Number of Required Antepartum Visits to Bill for Global Obstetric Care
  • Update for Select ICD-10-CM/PCS Codes End-Dated in 2025
  • Breast and Cervical Cancer Treatment Program Application Update
  • SNF WQIP Interim Payment Delay for the 2024 Program Year
  • Reminders and Updated Billing Guidelines for Street Medicine

For detailed information regarding these changes, please refer to:

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.

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