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Provider Update

Provider Update No. 189

Date: April 16, 2026

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:

  • 2026 HCPCS Quarter 2 Update
  • Presumptive Eligibility Provider Instruction: Erroneous Income Denials for 2026 FPLs
  • ICD-10-CM Diagnosis Code Requirement Removed for HCPCS Code Q2042
  • Select Cardiac Codes Split-Bill Percentage Update
  • Fee Schedule Rate Update for 2024 Codes
  • PLA Codes 0527U and 0571U, CPT Code 87513 Are Now Medi-Cal Benefits
  • Frequency Limit and Billing Instructions Updated for HCPCS Code Q2058
  • Continuous Glucose Monitor Systems Are Medi-Cal Rx Benefits
  • Medi-Cal Hospice Rates Updated for 2025 Through 2026
  • Provider Manual Revisions
  • Important Reminder: Ordering, Referring and Prescribing (ORP) Enrollment Requirements
  • San Diego County PACE Managed Care Plans Updates
  • April 2026 Update to AEVS: Carrier Codes for Other Health Coverage
  • DME Rental Policy Clarification
  • Correction to Orthotic and Prosthetic Appliances and Services Manual Section
  • 2026 ICF/DD, ICF/DD-H and ICF/DD-N Reimbursement Rates
  • New Provider Type 116 for CCS MTUs

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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