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Medi-Cal Announces Delay on Changes In Medical Supply Billing
As a result of advocacy by CAMPS the DHCS has announced a delay in the implementationof changes that would have taken effect on 2/1/20. We had many questions about the changes, the burden on provider to implement changes, and how these changes would impact reimbursement and documentation. The delay is stated as "indefinite" but it is likely that the changes would be implemented in the coming months. We will keep you informed as new information becomes available.
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Medical Supply Billing Codes Are Not Yet Updated to DME Supply Billing Codes
A previously published Medi-Cal Update article titled "Policy for Medical Supply Billing Codes Updated to DME Supply Billing Codes" notified providers that, effective for dates of service on or after February 1, 2020, certain medical supply billing codes are updated to Durable Medical Equipment (DME) supply billing codes, certain DME codes are added and certain medical supply codes policy is changed. The policy from that article will not be implemented at this time, including policy regarding benefit status and billing requirements. Until further notice, the following items continue to be reimbursable as medical supply codes and are not yet reimbursable as DME supply codes:
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HCPCS Code
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Description
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A4230
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Infusion set for external insulin pump, non needle cannula type
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A4231
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Infusion set for external insulin pump, needle type
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A4232
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Syringe with needle for external insulin pump, sterile, 3 cc
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A4483
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Moisture exchanger, disposable, for use with invasive mechanical ventilation
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A7002
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Tubing, used with suction pump, each
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A7003
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Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
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A7004
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Small volume nonfiltered pneumatic nebulizer, disposable
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A7006
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Administration set, with small volume filtered pneumatic nebulizer
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A7007
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Large volume nebulizer, disposable, unfilled, used with aerosol compressor
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A7008
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Large volume nebulizer, disposable, prefilled, used with aerosol compressor
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A7010
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Corrugated tubing, disposable, used with large volume nebulizer, 100 ft
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A7012
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Water collection device, used with large volume nebulizer
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A7013
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Filter, disposable, used with aerosol compressor or ultrasonic generator
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A7016
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Dome and mouthpiece, used with small volume ultrasonic nebulizer
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B4035
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Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape
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S8186
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Swivel adaptor
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Until further notice, medical supplies HCPCS code A4223 (infusion supplies not used with external infusion pump, per cassette or bag) continues to be reimbursable for infusion supplies with or without an infusion pump. HCPCS code A4222 (infusion supplies for external drug infusion pump, per cassette or bag) is not yet reimbursable as a DME supply.
Until further notice, the following HCPCS codes are not yet reimbursable:
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HCPCS Code
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Description
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A4224
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Supplies for maintenance of insulin infusion catheter, per week
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A4225
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Supplies for external insulin infusion pump, syringe type cartridge, sterile, each
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E0574
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Ultrasonic/electronic aerosol generator with small volume nebulizer
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Until further notice, the following medical supplies codes are no longer end-dated and continue to be reimbursable:
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HCPCS Code
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Description
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B9998
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Extension set for enteral feeding
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B9999
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Infusion supplies not otherwise classified
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S1015
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IV tubing extension set
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Providers are encouraged to check the Medi-Cal website regularly for updates.
Updated manual pages and the updated Medical Supplies Billing Codes, Units and Quantity Limits spreadsheet reflecting this change will be released in a future Medi-Cal Update.
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Medtrade Spring Room Discounts
Advance Rates are valid for Medtrade Spring through Feb. 22.
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One Capitol Mall, Suite 800
Sacramento, CA 95814
t: (916) 443-2115
f: (916) 444-7462
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