DHCS Releases Policy and Procedure Letter Confirming Psychology Assessment CPT Code Change

On December 10, 2018, DHCS released PPL 18-029 that, due to a change from the American Medical Association (AMA), DHCS will be eliminating the Current Procedural Terminology (CPT) Code 96101 for IEP/IFSP Psychological Assessments and replacing it with CPT Code 96130. This will apply to all assessment types of Initial, Triennial, Annual and Amended. The interim rates and modifiers will remain...

DHCS Updates Ordering, Referring, and Prescribing (ORP) Provider Enrollment Rules

On November 30, 2018, the Department of Health Care Services (DHCS) notified LEAs that their Provider Enrollment Division (PED) has updated the enrollment rules effective for all Ordering, Referring and Prescribing (ORP) application packages received on or after March 20, 2018. The effective date of enrollment for an approved ORP provider shall be one year prior to the date DHCS received the...

DHCS Documents Updated for 2016 Transportation Changes

On November 14, 2018, DHCS released PPL 18-027; this PPL is confirmation that DHCS updated their materials to accommodate the State changes made in 2016; it includes a link to the DHCS Transportation Billing Guide now updated to reflect these changes. As a reminder, special-education students’ medically necessary transportation in a litter van, wheelchair van, or a school bus equipped with...

Change in CPT Code for IEP/IFSP Psychological Assessments and More

Beginning in the first quarter of 2019, due to a change from the American Medical Association (AMA), DHCS will be eliminating the Current Procedural Terminology (CPT) Code 96101 for IEP/IFSP Psychological Assessments and replacing it with CPT Code 96130. This will apply to all assessment types of Initial, Triennial, Annual and Amended. The interim rates and modifiers will remain unchanged....

RMTS for LEA Billing—DHCS Hosts Combined Stakeholder Meeting on Oct. 4, 2018

On Thursday, Oct. 4, 2018, the Department of Healthcare Services (DHCS) held the first LEA Billing and School Medi-Cal Administrative Activities (SMAA) combined meeting. Paradigm attended the meeting by webinar and below are the highlights. There are 2 issues DHCS is still working out with CMS before formally submitting the final version of the SPA, which includes RMTS for LEA Billing, for...

LEA Ad-Hoc Advisory Workgroup Publishes August 2018 Meeting Minutes

The LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE), held their regularly scheduled meeting to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program. Highlights from the August 1, 2018 meeting minutes include: The Annual Report for FY 2017/18 has been posted to the DHCS website. No...

LEA Ad-Hoc Advisory Workgroup Publishes June 2018 Meeting Minutes

The LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE), held their regularly scheduled meeting to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program. Highlights from the June 6, 2018 meeting minutes include: All LEA's Data Use Agreements (DUA) with DHCS are set to expire December 1,...

July Medi-Cal Bulletin for LEAs Posted – LEA Provider Manual Updates

The July Medi-Cal Bulletin for LEAs has been published to the DHCS website. One item of interest are updates to the LEA Provider Manual that reflect the change in withhold percentage from 1.5% to 2% and adding the location of service to the list of items that must be documented for all services (Paradigm clients, we have you covered here and there is no action required on your part). For...

June Medi-Cal Bulletin for LEAs Posted – Updated Withhold Percentage & OT/PT Benefits Update

The June Medi-Cal Bulletin for LEAs has been published to the DHCS website. Two items of interest include: Effective for dates of service on or after July 1, 2018, the 1.5 percent withhold levied against Local Educational Agency (LEA) reimbursements, which covers audit administration and associated audit costs, is increased to 2 percent. The 1 percent administrative withhold for claims...

LEA Ad-Hoc Advisory Workgroup Publishes April 2018 Meeting Minutes

The LEA Ad-Hoc Advisory Workgroup, comprised of LEA representatives, DHCS, and the California Department of Education (CDE), held their regularly scheduled meeting to make recommendations and discuss issues impacting the LEA Medi-Cal Billing Option Program. Highlights from the April 4, 2018 meeting minutes include: OIG (the federal Office of Inspector General) is auditing the LEA Billing...