Based on Medi-Cal Bulletins and NewsFlashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- Update to the List of Contracted Waterproof Sheeting
- HCPCS Code J1412 Dosing Based on Weight Update
- Required Modifiers LT and RT Added to HCPCS Code Q5155
- Clarified Guidance for Billing HCPCS Codes S5110 and S5111 for BHT Services
- CCS Gait Analysis Studies Billing Policy Reminder
- 2025 Clinical Laboratory Services Rate Update
- TAR Requirement Removed for HCPCS Code J9309
- Rate Update for Durable Medical Equipment
- Maximum Dose Update for HCPCS Code J3402
- Pulse Oximetry CPT Codes 94761 and 94762 are Medi-Cal Benefits
- CPT Surgery Code 66174 Added as a Benefit
- Diagnosis Restrictions Removed for CPT Codes 84702 and 84703
- Updated: Medi-Cal List of Contracted Incontinence Absorbent Products
- Provider Dispute Resolutions with Managed Care Plans
- Updates to the Medi-Cal List of Contracted Incontinence Creams and Washes
- Provider Manual Revisions
- Medi-Cal Adult Expansion Freeze Begins January 2026
- Reminder: Provider Guidelines for ORP Provider Enrollment Requirements
- November 2025 Update to AEVS: Carrier Codes for Other Health Coverage
- Auditory Diagnosis Codes 92622 and 92623 Covered Under HACCP
- Justice-Involved (JI) Reentry Initiative: FQHC and RHC Providers Authorized to Provide JI Services
- 2026 Rate Increase for HCBS Waivers and Programs
- FS/NF and FS/SA Workforce Standards Program Rates for Calendar Years 2024 and 2025
- Ordering, Referring and Prescribing (ORP) Web Page No Longer Available
- Notification: DRG Payment System Update to Hospital-Acquired Condition V43.0
- National Correct Coding Initiative Quarterly Update for October 2025: PTP Replacement File
- Reminder: Timely Transfer of Care and/or Consultation for Pregnant or Postpartum Medi-Cal Members
For detailed information regarding these changes, please refer to:
- General Medicine Bulletin 617
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine - Medi-Cal Program & Eligibility Bulletin 40
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=medi-cal-program-and-eligibility, - Audiology and Hearing Aids Bulletin 602
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=audiology-and-hearing-aids - Clinics and Hospitals Bulletin 614,
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=clinics-and-hospitals - Home Health Agencies/Home and Community-Based Services Bulletin 614
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=home-health-agencieshome-and-community-based-services - Medi-Cal NewsFlashes
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33310
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33667
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33587.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/31896.14
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33728
To access the updated Physician Administered Drug Prior Authorization List (PAD PA List), please refer to
https://www.caloptima.org/en/for-providers/claims-and-eligibility/prior-authorizations.