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:
- General Medicine Bulletin 609
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=generalmedicine - Medi-Cal Program & Eligibility Bulletin 33
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=medi-calprogram-and-eligibility - Durable Medical Equipment and Medical Supplies Bulletin 595
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=durablemedical-equipment-and-medical-supplies - Clinics and Hospitals Bulletin 607
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=clinicsand-hospitals - Home Health Agencies/Home and Community-Based Services Bulletin 607
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=homehealth-agencieshome-and-community-based-services - Long Term Care Bulletin 578
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=long-termcare - Medi-Cal Newsflashes
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33257.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33373
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33398
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33404
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33375.01
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.