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 3 Update
- Modifications to the DETEC Application in the Provider Portal
- TAR Requirements for Subacute Care Programs
- Cell and Gene Therapy Policy Updates and New Manual Sections
- Additional Gene Tests Covered Under CPT Code 81403
- HCPCS Code G0561 Benefit Status Change
- Additional Dyadic Modifiers Added to Existing Dyadic Service Billing Codes
- Policy Updates for Auditory Osseo Integrated Implant CPT Codes
- Provider Manual Revisions
- Claim Criteria for Select Psychiatric Inpatient Hospital Services
- Reminder: Medi-Cal Provider Agreement Compliance Requirements
- 2025 Nursing Facilities – Level A Reimbursement Rate Update
- Update to the TAR Requirement for Select Breast Pump HCPCS Codes
- Seven Fact 2mg Payment Correction
- Justice-Involved (JI) Reentry Initiative: Former Foster Youth Update
- Enhancements to Appeal Status in Correspondence Center
- Reimbursement for Behavioral Health Treatment Services Provided to Medi-Cal Members with Fee-for-Service
- Important Update: House Resolution (HR) 1– Federal Payments to Prohibited Entities
For detailed information regarding these changes, please refer to:
- General Medicine Bulletin 613
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=generalmedicine, - Inpatient Services Bulletin 610
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=inpatientservices - Long Term Care Bulletin 581
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=long-termcare - Pharmacy Bulletin 1068
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=pharmacy - Medi-Cal Newsflashes
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33369.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32984.69
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33062.68
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33416.02
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33547
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.