January 24, 2019
Area(s) of Interest: Practice Management Public Payors Payor Issues and Reimbursement
The California Department of Health Care Services (DHCS) has confirmed that the 2019 CPT/HCPCS updates have been loaded to the Medi-Cal system and were effective January 1, 2019.
Every year, the Centers for Medicare and Medicaid Services (CMS) issues new, updated and terminated CPT and HCPCS codes. However, in past years it has taken DHCS up to 10 months to update its system with the new or updated codes and pricing. This has caused unnecessary delays and denials in payment not only on Medi-Cal fee-for-service claims, but also for many Medi-Cal managed care claims, as the plans follow Medi-Cal payment rules.
DHCS has committed to making these changes by January 1 each year going forward, to prevent these delays and denials. This is a welcome change for which the California Medical Association has been advocating. CMA applauds this action by DHCS, as it will ensure affected claims are paid correctly and in a timely manner. The January 1 effective date will mirror the implementation date applied by all other payors and avoid these delays and improper denials caused.
The Medi-Cal reimbursement rates page has also been updated to reflect pricing for the new codes.