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
- New PACE Managed Care Plans
- Justice-Involved (JI) Reentry Initiative: Authorized Provider Types Updated
- CLIA-Waived Test Reimbursement for Pharmacy Providers
- Required ICD-10-CM Diagnosis Codes Updated for HCPCS J1756
- Code 0345U is a New Medi-Cal Benefit
- Modifier SL Allowable for CPT Code 90661
- Additional CLIA-Waived Tests Procedure Codes
- Updated Hospice Reimbursement Rates
- CPT Code 87636 is Reimbursable as a CLIA-Waived Test
- Frequency Update to PLA Codes 0037U, 0120U, 0239U, 0244U, 0287U and 0314U
- Genetic Testing and Counseling Services Clarification
- LMFT Services for IHS-MOA and Tribal FQHC Providers New Effective Date
- New TAR and Non-Benefit List Provider Manual Sections
- Clarification of Non-Benefit Billing Policy with an Approved Treatment Authorization Request
- Policy Update for Echography and Radiological Ultrasound CPT Codes
- Contracted Medi-Cal Fee-For-Service Intermittent Urinary Catheter Supplies Update
- Provider Manual Revisions
- TAR Criteria Update for Select DME HCPCS Code
- The EWC DETEC User Guide has been Updated
- Important July 31, 2025, Update: H.R. 1– Federal Payments to Prohibited Entities
- Date Extended for the Behavioral Health Migration to the Provider Portal
- CPT Code 90382 is Reimbursable for Billing Enflonsia
For detailed information regarding these changes, please refer to:
- Medi-Cal Program & Eligibility Bulletin 37
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=medi-cal-program-and-eligibility, - General Medicine Bulletin 614
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=general-medicine - Durable Medical Equipment and Medical Supplies Bulletin 599
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/publications/bulletin?community=durable-medical-equipment-and-medical-supplies - Medi-Cal Newsflashes
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33062.75
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33557.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33062.82
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33554.01
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.