Based on Medi-Cal Bulletins and Newsflashes, CalOptima Health has updated the procedure codes and other relevant information for the subjects listed below:
- Rebranding Presumptive Eligibility for Pregnant Women
- Justice-Involved (JI) Reentry Initiative: JI Going Live
- Policy Correction: CPT Codes 76811 and 76817 Not Reimbursable for Licensed Midwives
- Policy Correction: CPT Codes 76802, 76810 and 76813 Not Reimbursable for Licensed Midwives
- HCPCS Codes Q0224 and M0224 for COVID-19 Therapeutics Added as a Medi-Cal Benefit
- CPT Codes 97014 and 97022 Added for Licensed Midwives
- Updated Licensed Midwives Evaluation and Management Codes
- Physician-Administered Drugs Added as Benefits for the JI Reentry Initiative
- CPT Code 81412 Updated to a Medi-Cal Benefit
- Place of Service Added for CPT Codes 90832, 90834, 90837 and 90791
- CPT Code 76805 No Longer Reimbursable for Licensed Midwife and Certified Nurse Midwife Services
- Update to Licensed Midwife and Certified Nurse Midwife Categories of Services
- Pharmacy Providers May Supervise and Bill for Community Health Worker Services
- Policy Information for Biomarker and Pharmacogenomic Testing Coverage
- Rates Update for HCPCS Codes A4269, J3490 and J7304
- Updated Mental Health Plan Contact Information
- National Correct Coding Initiative Quarterly Update for October 2024
- Provider Manual Revisions
- 2025 Whole Child Model Transition
- Updated LEA Billing Option Program Reimbursement Rates for the Fiscal Year 2024-2025
- 2024 Freestanding Pediatric Subacute Facilities Reimbursement Rate Update
- 2024 Nursing Facilities – Level A Reimbursement Rate Update
- Coming Soon: Billing Clarification for Dyadic Services and Timeless Waiver for FQHC, RHC and THP Programs CalOptima Health, A Public Agency
- First Phase for Single Subscriber Eligibility and Share of Cost Applications Update
- Reminder for Split Billing Inpatient Services
- CPT Codes for Family PACT Updated for E&M Office Visits
- September 2024 SNF WQIP Update
- New Aid Codes for JI Initiative
- Telehealth Modifiers Update for FQHC, RHC, IHS-MOA and Tribal FQHC Providers
For detailed information regarding these changes, please refer to:
- General Medicine Bulletin 603
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=general-medicine - Medi-Cal Program & Eligibility Bulletin 26
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=medi-cal-program-and-eligibility - Local Educational Agency Bulletin 600
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=local-educational-agency - Long Term Care Bulletin 571
https://mcweb.apps.prd.cammis.medical.ca.gov/publications/bulletin?community=long-term-care - Medi-Cal NewsFlashes
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33075
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33081
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/3307
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33024
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33079.01
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/32365.02
https://mcweb.apps.prd.cammis.medi-cal.ca.gov/news/33094
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.