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Updates in Medi-Cal Provider Bulletin

Here are two updates from the March Medi-Cal DME Provider Bulletin. The first, on the CRT exemption from the 10% cut, was in a previous member blast. The EPC will be run on prior claims retro to 1/1/22.

 

The second reflects ongoing efforts by CAMPS to have DHCS recognize the increased costs of providing enteral formula and supplies. That conversation includes medical supplies in general and the need to eliminate the 10% reduction and recognize increased costs of good and delivery.

Exemption of Specific DME Procedure Codes

from Payment Reduction

Effective retroactively for dates of service on or after January 1, 2022, specific Durable Medical Equipment (DME) Complex Rehabilitation Technology (CRT) and Complex Rehabilitation Technology Services (CRTS) are exempt from Assembly Bill (AB) 97 10 percent payment reduction.


An Erroneous Payment Correction (EPC) will be implemented to reprocess paid claims for specific DME CRT and CRTS that were subject to the 10 percent payment reduction effective retroactively for dates of service on or after January 1, 2022. There is nothing additional for providers to submit at this time.

Updates to Enteral Feeding Supplies MAPC

Effective for dates of service on or after April 1, 2023, the maximum allowable product cost (MAPC) for certain enteral nutrition feeding supplies HCPCS billing codes has been updated as follows:

Quantity and frequency restrictions apply and remain unchanged.

As of April 1, 2023, a Universal Product Number (UPN) code will be required for HCPCS code B9998 on the claim for reimbursement.


Note: A UPN is a product identifier which is encapsulated in the bar code media of the product. All UPNs are variable length alphanumeric strings of either 14 or 20 characters.


Providers may refer to the manufacturer’s website for UPN billing codes as these will not be listed nor restricted to a DHCS-covered List. The UPN billed should match the product billed, reimbursed, and dispensed to the beneficiary.