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Provider Update

Provider Update No. 178

Date: May 16, 2025

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:

  • 2025 HCPCS Quarter 2 Update
  • Genetically Handicapped Persons Program Reimbursement Process
  • May 2025 CCS Service Code Groupings Policy Update
  • Update to Medi-Cal Telehealth Policy for Brief Virtual Communications and Check-ins Using CPT Code 98016
  • HCPCS Code J9172 Is Now a Medi-Cal Benefit
  • TAR Criteria Update for Select PLA Codes
  • Policy Update for HCPCS Code J1756
  • Coming Soon: Updated Medi-Cal Coverage for Behavioral Health Treatment Services
  • Provider Manual Revisions
  • Updated ICD-10-CM Codes for HCPCS Code E3200
  • 2025 Pediatric Subacute Facilities Reimbursement Rate Update
  • Calendar Year 2024 Clinical Laboratory and Laboratory Services Data Collection
  • Notification: DRG Payment System Update to Hospital-Acquired Condition V42.1 on April 1, 2025
  • Justice-Involved (JI) Reentry Initiative: Correction for FQHC, RHC, Tribal FQHCs and IHSMOA Clinics
  • New Public Fee-For-Service Provider Directory: Action Required
  • Medically Necessary Gender-Affirming Care Services Covered for Medi-Cal Members
  • National Correct Coding Initiative Quarterly Update for 2025: Quarter 2 MUE Replacement Files
  • Reminder: Notice of Election Form Requirement for Medi-Cal Hospice Providers

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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