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Provider Update

Provider Update No. 180

Date: July 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 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:

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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