Medi-Cal Provider Training...

NICU/PICU Services

Medi-Cal

Provider

Training

2019

NICU/PICU Services

June 2019 1

Neonatal and Pediatric Intensive Care Unit (NICU/PICU) Services

Introduction

Purpose:

The purpose of this module is to provide information regarding the Neonatal and Pediatric Intensive Care Unit (NICU/PICU) HIPAA-Compliant Code Conversion effective June 1, 2019.

Module Objectives:

Define the NICU program

Define the PICU program

Describe California Children’s Services (CCS) program physician paneling

Define approved facilities

Describe Service Code Groupings (SCGs)

Explain the Service Authorization Request (SAR) requirements, completion and submission

Describe initial codes, subsequent codes and levels of care

Describe modifiers and block billing

Describe national procedure codes and crosswalk

Describe Computer Media Claims (CMC) billing and testing

Provide resource information

Acronyms

A list of current acronyms is located in the Appendix section of the workbook.

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Background

California has historically used thousands of HCPCS Level III or local codes (also known

as interim codes) for billing and reimbursement of services and supplies. National codes, such as CPT codes, are typically more specific in nature compared to local codes. Using HIPAA-compliant CPT codes:

Simplifies the process and decreases the cost associated with payment for health care services;

Improves the efficiency and effectiveness of the health care system and decreases administrative burdens on providers (for example, medical practices, hospital and healthcare plans);

Provides standardization and consistency in medical service coding;

Characterizes a general administrative situation, rather than a medical condition or service, by using non-clinical or non-medical code sets.

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June 2019 3

Overview

For claims with dates of service on or after June 1, 2019, HCPCS Level III local codes

Z0100, Z0102, Z0104, Z0106 and Z0108 are converting to more specific CPT national codes.

The NICU/PICU Services Code Conversion establishes HIPAA-compliant procedure

codes and terminates the use of HCPCS Level III local codes. The update references

valid CPT national codes for billing intensive care unit services for both neonatal and pediatric services. The purpose of the service is to provide care to ill infants and children in an environment that is sensitive to the needs of the infant or child and the family.

HIPAA-compliant CPT codes are required to bill for the face-to-face (one-on-one) visit with the beneficiary on or after June 1, 2019.

The claim may consist of one of the following:

CPT national code

CPT national code with modifier(s)

NOTE For dates of service on or after June 1, 2019, only claims submitted with CPT national codes for NICU/PICU services are reimbursable.

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4 June 2019

NICU Program Overview

A NICU is an intensive care unit specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days after birth; however, some infants may require NICU care beyond this period. Most newborn infants admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 2500 grams), or have a medical condition that requires special care.

PICU Program Overview A Pediatric Intensive Care Unit (PICU) is an area within a hospital that provides intensive care and monitoring to infants, children, teenagers and individuals up to 21 years of age with serious medical, surgical or traumatic conditions.

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CCS Provider Paneling

A paneled provider is a physician who wishes to provide NICU/PICU services for CCS-eligible beneficiaries.

To become a paneled provider the CCS program determines if the providers meet the advanced education, training and/or experience requirements for his/her provider type in order to render services to a CCS client.

CCS Provider Paneling

CCS paneling is required for the following providers in order to treat beneficiaries with a CCS-eligible condition:

Audiologists

Dietitians

Occupational Therapists

Orthotists

Pediatric Nurse Practitioners *

Physical Therapists

Physicians

Podiatrists

Prosthetists

Psychologists

Registered Nurses *

Respiratory Therapist *

Social Workers

Speech Language Pathologists

*Provider type is subject to program participation limitations. For additional information, refer to the individual provider type description in the Medi-Cal provider manual.

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6 June 2019

CCS Provider Paneling Application Process

Physicians, podiatrists, and allied health care professionals must apply online at (https://cmsprovider.cahwnet.gov/PANEL/index.jsp). The supporting documentation that is needed to review the provider’s application may be faxed to (916) 440-5299 or emailed to [email protected].

For more information regarding CCS provider paneling, email the Provider and Facility Enrollment Unit at: [email protected]

CCS-Approved Facilities

Types of CCS-Approved Hospitals

An approved NICU is defined as a nursery within a CCS-approved hospital that has the capability of providing a full range of neonatal care services (intensive, intermediate and continuing care). Also, a regional, community, or intermediate hospital, which has been determined to meet the requirements for a CCS client, according to specified level of NICU care.

A PICU is a unit within a CCS-approved Tertiary or Pediatric Community Hospital. The PICU unit has the capability of providing definitive care for a wide range of complex, progressive, rapidly changing, medical, surgical and traumatic disorders, requiring a multidisciplinary approach to care for those under 21 years of age who meet CCS medical eligibility criteria.

Only CCS eligible hospitals may provide CCS NICU/PICU Services. The definitions of the hospitals are as follows:

Tertiary Hospital

A tertiary hospital is a referral hospital, providing comprehensive, multidisciplinary, regionalized pediatric care to children from birth up to 21 years of age. The length of stay in a tertiary hospital may exceed 21 days. This approval covers teaching hospitals, children’s and university hospitals, and their major affiliates with approved residency programs in pediatrics and all other major specialties.

https://cmsprovider.cahwent.gov/PANEL/index.jsp

mailto:[email protected]

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Pediatric Community Hospital

A pediatric community hospital is a community-based hospital with licensed pediatric beds providing services for children from birth up to 21 years of age. The length of stay in an approved pediatric community hospital shall not exceed 21 days, except in the case of care provided in a CCS-approved community or intermediate level NICU.

General Community Hospital

A general community hospital is a community-based hospital without licensed pediatric beds in which care is provided only for adolescents 14 years of age up to 21 years of age. The length of stay in an approved general community hospital shall not exceed 21 days, except in the case of care provided in a CCS-approved community or intermediate NICU.

Special Hospital

A special hospital is a licensed acute care hospital that meets one of the following requirements:

Provides licensed perinatal units/services including intensive care for newborns and meets the CCS standards as a community or intermediate NICU.

Is licensed under special permit for rehabilitation services and meets CCS standards as a rehabilitation facility.

Provides services in specialized areas of medical care and acts as a regional referral center for specialized type of care (for example, eye surgery and ear surgery or burn center).

Limited Hospital

Limited hospitals are located in rural areas where no community or tertiary inpatient hospital services are available. These hospitals do not have licensed pediatric beds, are capable of providing limited services to children and adolescents for acute, short-term conditions for which the expected length of stay does not exceed five days.

Special Care Centers (SCCs)

The CCS program has a system of Special Care Centers (SCCs) throughout the State, providing comprehensive, coordinated health care to children with complex, handicapping medical conditions. SCCs are multidisciplinary teams, which evaluate a client’s medical condition and develop a comprehensive, family-centered plan of health care for the beneficiary. SCCs facilitate provision of timely, coordinated treatment for the CCS client. SCCs are usually located in conjunction with CCS-approved, hospital-level medical centers. Each SCC is individually reviewed and approved by CCS to ensure that it complies with CCS program standards.

A list of CCS’s approved facilities is available on the “California Children’s Services” web page at: (www.dhcs.ca.gov/services/ccs). Click the “Special Care Center Directory” link under the County CCS Programs heading.

Providers may search the directory according to CCS type, such as cardiac or craniofacial; facility or hospital name; or SCC number.

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Service Code Groupings (SCGs) An SCG is a group of procedure codes authorized to a CCS-approved provider for the provision of a group of related health care services authorized through the Service Authorization Request (SAR) process. An SCG SAR enables the provider to render care to a CCS client without obtaining repeated procedure-specific SARs.

NICU/PICU provider (physician and physician groups) SCGs are:

01-Physician

02-Special Care Center

03-Transplant Centers

07-Orthopedic Surgeon

NOTE

SCG 51 is an excluded SCG for Physician Surgical Services. For additional information, please refer to (http:www.dhcs.ca.gov/services/ccs/documents/ccsnl020510.pdf).

For additional information on SCGs, please refer to California Children’s Services (CCS) Program Service Code Groupings (cal child ser) section of the appropriate Part 2 provider manual.

Service Authorization Request (SAR)

SAR Policy Effective Date

Effective for dates of service on or after June 1, 2019, NICU/PICU providers may no

longer submit SARs with HCPCS Level III local codes.

Providers must request existing SARs with the HCPCS Level III local codes be end-

dated effective May 31, 2019, and submit a new SAR with the appropriate CPT national code(s) to cover any remaining service period on or after June 1, 2019.

Claims billed with HCPCS Level III local codes on or after June 1, 2019, are denied with

Remittance Advice Detail (RAD) Code 9662 – service authorization status not active.

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SAR Requirements

The CCS program requires authorization for health care services related to a client’s CCS eligible medical condition. Providers must submit a SAR to a CCS county or state office. Only active Medi-Cal providers may receive authorization to provide CCS program services. Services may be authorized for varying lengths of time during the CCS client’s eligibility period. Providers may request services for CCS clients using one of the following SAR forms:

New Referral CCS/GHPP Client Service Authorization Request (SAR) (DHCS 4488)

CCS/GHPP Discharge Planning Service Authorization Request (SAR) (DHCS 4489)

Established CCS/GHPP Client Service Authorization Request (SAR) (DHCS 4509)

The CCS/GHPP Discharge Planning SAR is used when requesting specific services for a CCS client who is discharged from an inpatient hospital stay.

The SAR forms are available at both the “California Children's Services (CCS) Forms” page of the Department of Health Care Services (DHCS) website: (http://www.dhcs.ca.gov/formsandpubs/forms/Pages/CCSForms.aspx) and on the “Forms” page of the Medi-Cal website:(http://files.medi-cal.ca.gov/pubsdoco/forms.asp).

Electronic SAR (eSAR) Requirements

CCS and Genetically Handicapped Persons program (GHPP) providers can submit SARs in an electronic format for fee-for-service claims. This feature aims to eliminate the paper SAR process for providers with internet connectivity.

To submit eSARs, providers must:

Register, or already be registered as an active Medi-Cal provider.

Have access to the Children’s Medical Services Network (CMS Net) Provider Electronic Data Interchange (PEDI) website.

Register, and be approved as a trading partner with DHCS, Integrated System of Care Division (ISCD) and CMS Net by agreeing to all the terms and conditions contained within the eSAR Trading Partner Agreement.

Registered providers, clearinghouses or managed care plans can complete and submit the eSAR requests on behalf of the providers and facilities in their network. Paper SAR submissions remain an option for low-volume SAR providers or submitters who may have technical limitations or other practical reasons to do so.

Providers interested in converting from paper SAR to eSAR submission should contact the CMS Net Help Desk at [email protected] or 1-866-685-8449 for helpful guidance and additional information.

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10 June 2019

NICU/PICU Services CPT Billing Codes

The following section describes the national codes that are replacing HCPCS Level III local codes Z0100, Z0102, Z0104, Z0106 and Z0108 on or after June 1, 2019.

Initial and subsequent codes

Initial service codes are reported when a neonate, infant or pediatric beneficiary receives care that is provided on the initial day (first or partial 24 hours).

Subsequent service codes are reported when a neonate, infant or pediatric beneficiary receives care that is provided after the initial day.

Patient-Specific Levels of Care

Initial and subsequent codes are further categorized into levels of care as listed below:

Critical: Children receiving ventilator support (including continuous positive airway

pressure [CPAP]), invasive monitoring, and/or intravenous pharmacological support of the circulatory system

Intensive: Cardiorespiratory monitoring for unstable physiology; for example, apnea or hypoglycemia

Non-Critical, Non-Intensive: Physiologic stability but requires support such as tube feeding, I.V. med or fluid

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Initial service codes:

Initial inpatient critical care; some of these codes have age restriction and some codes

are age specific.

CPT Codes Description

99291 Critical care, evaluation and management of the critically ill or

critically injured patient; first 30-74 minutes

99468 Initial patient neonatal critical care, per day, for the evaluation

and management of a critically ill neonate; 28 days of age or

younger

99471 Initial patient pediatric critical care, per day, for the evaluation

and management of a critically ill infant or young child; 29

days through 24 months of age

99475 Initial patient pediatric critical care, per day, for the evaluation

and management of a critically ill infant or young child; 2

through 5 years of age

Initial Intensive Care; this code has an age restriction.

CPT Code Description

99477 Initial hospital care, per day, for the evaluation and

management of the neonate, 28 days of age or younger, who

requires intensive observation, frequent interventions, and

other intensive care services

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Initial Non-Intensive, Non-Critical Care; these codes have guidelines for key-components

and time spent at bedside.


99222 Initial care, per day, for the evaluation and management of a

patient, which requires these 3 key components:

A comprehensive history;

A comprehensive examination; and

Medical decision making of moderate complexity

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s family and/or family’s needs.

Usually, the problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99223 Initial care, per day, for the evaluation and management of a

patient, which requires these 3 key components:



Medical decision making of high complexity


Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit.

Subsequent service codes:

Subsequent inpatient critical care; some of these codes have age restrictions.


99292 Critical care, evaluation and management of the critically ill or

critically injured patient, each additional 30 minutes

99469 Subsequent inpatient neonatal critical care, per day, for the

evaluation and management of a critically ill neonate, 28

days of age or younger

99472 Subsequent inpatient pediatric critical care, per day, for the

evaluation and management of a critically ill infant or younger

child, 29 days through 24 months of age

99476 Subsequent inpatient pediatric critical care, per day, for the

evaluation and management of a critically ill infant or young

child, 2 through 5 years of age

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Subsequent Intensive Care; these codes have weight restrictions.

CPT Code Description

99478 Subsequent intensive care, per day, for the evaluation

and management of the recovering very low birth

weight infant (present body weight less than 1500

grams)


and management of the recovering low birth weight

infant (present body weight of 1500-2500 grams)


and management of the recovering infant (present body

weight of 2501-5000 grams)

Subsequent Non-Intensive, Non-Critical Care; these codes have guidelines for key-

components and time spent at bedside.


99232 Subsequent hospital care, per day, for the evaluation

and management of a patient, which requires at least 2

of these 3 key components:

An expanded problem focused interval history;

An expanded problem focused examination;



Usually, the patient is stable, recovering or improving. Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99233 Subsequent hospital care, per day, for the evaluation

and management of a patient, which requires at least 2

of these 3 key components:

A detailed interval history;

A detailed examination;



Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.

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Modifiers Use modifiers to supplement information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Modifiers codes help further describe a procedure code without changing its definition.

Modifiers TG and HA are only applicable when billing with CPT national codes 99291 and 99292 for dates of service on or after June 1, 2019:

Applicable modifiers when billing with CPT codes 99291 and 99292

Modifier Description

TG complex/high tech level of care

HA child/adolescent program

The only instances where a modifier is required is for 99291 and 99292, when rendered at an approved NICU/PICU facility.

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Block Billing Block billing (split claims), also known as “from-through” billing, is a method of billing that allows providers to bill for the same service rendered on different dates of service, without having to complete a separate claim line for each date of service. With the exception of prolonged inpatient evaluation and management (E&M) service code 99292, NICU/PICU providers (physician and physician groups) may use this billing method.

Bill on separate claims for dates of service prior to June 1, 2019, containing HCPCS

Level III local codes, and for dates of service on or after June 1, 2019, containing

HIPAA-compliant CPT codes. Providers should refer to the CMS-1500 Special Billing Instructions (comes spec) section of the appropriate Part 2 provider manual for additional information and a billing example of block billing.

Block Billing Example CMS-1500

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Crosswalk to NICU/PICU Billing Code Sets

Policy Effective June 1, 2019

Refer to the table below for CPT national codes that are replacing HCPCS Level III local

codes Z0100, Z0102, Z0104, Z0106, and Z0108.

Local Code – Description National Billing Codes Sets

Z0100 – Initial neonatal

and pediatric intensive care

(first or partial 24 hours)

For Critically ILL Patients

CPT Code – Description Modifier – Description Billing Considerations

99468 – Initial inpatient neonatal critical

care, per day, for the evaluation and

management of a critically ill neonate,

28 days of age or younger

99471 – Initial inpatient pediatric critical

care, per day, for evaluation and

management of a critically ill infant or

young child, 29 days through 24 months

of age

99475 – Initial inpatient pediatric critical

care, per day for the evaluation and

management of a critically ill infant or

young child, 2 through 5 years of age

99291 – Critical care, evaluation and

management of the critically ill or

critically injured patient; first 30-74

minutes

TG – Complex/high tech

level of care

And/or

HA – Child/adolescent

program

PICU admit > 5 years.

Billable once per day.



critically injured patient; each additional

30 minutes


level of care

And/or


program

PICU admit > 5 years

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Z0100 – Initial neonatal

and pediatric intensive care

(first or partial 24 hours)

For Initial Non-Critical, Non-Intensive (Neonatal or Pediatric)


99477 – Initial hospital care, per day, for

the evaluation and management of the

neonate, 28 days of age or younger,

who requires intensive observation,

frequent interventions, and other

intensive care services

99222 – Initial care, per day, for the

evaluation and management of a

patient, which requires these 3 key

components:





Usually, the problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99223 – Initial care, per day, for the

evaluation and management of a

patient, which requires these 3 key

components:





Usually, the problem(s) requiring admission are of high severity. Typically, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit.

NICU/PICU Services

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Z0102 – Category I level of

care: Children receiving

ventilatory support

(including continuous

positive airway pressure

[CPAP]), invasive

monitoring, hyper

alimentation, and/or

intravenous

pharmacological support of

the circulatory system

Z0104 – Category II level

of care: Children receiving

intensive therapy and

intravenous lines for

medications or fluids,

supplemental oxygen

and/or feedings via

nasogastric, orogastric,

nasojejunal or gastrostomy

tubes

Z0106 – Category III level

of care: Children who are

unstable, requiring frequent

monitoring and assessment

by trained personnel

Z0108 – Category IV level


stable, receiving routine

medical and nursing care

prior to discharge from the

NICU/PICU (may be used

to bill the last day of care in

the NICU/PICU).

For Critically ILL Patients:


99469 – Subsequent inpatient neonatal

critical care, per day, for the evaluation

and management of a critically ill

neonate, 28 days of age or younger

99472 – Subsequent inpatient pediatric


and management of a critically ill infant

or young child, 29 days through 24

months of age

99476 – Subsequent inpatient pediatric


and management of a critically ill infant

or young child, 2 through 5 years of age



critically injured patient, first 30-74

minutes


level of care

And/or


program

PICU admit > 5 years.

Billable once per day.



critically injured patient, each additional

30 minutes


level of care

And/or


program

PICU admit > 5 years

Newborns Requiring Intensive Care, Not Critically ILL:


99478 – Subsequent intensive care, per

day, for the evaluation and

management of the recovering very low

birth weight infant (present body weight

less than 1500 grams)



management of the recovering low birth

weight infant (present body weight of

1500-2500 grams)

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June 2019 19




ventilatory support



[CPAP]), invasive

monitoring, hyper


intravenous








supplemental oxygen

and/or feedings via



tubes

Z0106 -- Category III level












the NICU/PICU).

Newborns Requiring Intensive Care, Not Critically ILL:




management of the recovering infant

(present body weight of 2501-5000

grams)

For Subsequent Non-Critical, Non-Intensive (Neonatal or Pediatric)


99232 – Subsequent hospital care, per


management of a patient, which

requires at least 2 of these 3 key

components:

An expanded problem focused

interval history;

An expanded problem focused

examination;

Medical decision making of

moderate complexity

Counseling and/or coordination of care

with other physicians, other qualified

health care professionals, or agencies

are provided consistent with the nature

of the problem(s) and the patient’s

family and/or family’s needs.

Usually, the patient is stable, recovering or improving. Typically, 25 minutes are spent at the bedside and on the patient’s hospital floor or unit.

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20 June 2019




ventilatory support



[CPAP]), invasive

monitoring, hyper


intravenous








supplemental oxygen

and/or feedings via



tubes

Z0106 -- Category III level












the NICU/PICU).

For Subsequent Non-Critical, Non-Intensive (Neonatal or Pediatric)


99233 – Subsequent hospital care, per


management of a patient, which

requires at least 2 of these 3 key

components:

A detailed interval history;

A detailed examination;

Medical decision making of high

complexity.

Counseling and/or coordination of care

with other physicians, other qualified

health care professionals, or agencies

are provided consistent with the nature

of the problem(s) and the patient’s

family and/or family’s needs.

Usually, the patient is unstable or has

developed a significant complication or

a significant new problem. Typically, 35

minutes are spent at the bedside and

on the patient's hospital floor or unit.

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June 2019 21

Computer Media Claims (CMC) Billing

CMC submissions are the most efficient method of Medi-Cal claims billing. Unlike paper claims, these claims already exist on a computer medium. Consequently, manual processing is eliminated. CMC submission offers additional efficiency to providers because these claims are submitted faster, and entered into the claims processing system faster. All CMC submission requires that providers have a computerized claims billing system or have contracted with a billing service that operates a computerized billing system. Generally, the claim submission requirements for CMC are the same as for paper claims

All CMC submitters must sign a telecommunications provider and Biller Application/Agreement form, test their CMC submission ability and be approved for the CMC submission process by DHCS and CA-MMIS.

Providers may refer to the CMC Enrollment Procedures (cmc enroll) in the appropriate Part 1 provider manual for additional guidelines.

For more information regarding CMC, providers may refer to the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual. For electronic claim submission questions, contact the Telephone Service Center (TSC) at 1-800-541-5555, select option “4” for the Technical Help Desk and option “2” for CMC.

System Testing

Once enrollment is complete and a submitter number has been assigned, submitters must send a test file to the Medi-Cal test site (sysdev.medi-cal.ca.gov) to ensure accurate file format, completeness and validity. Any format problems discovered during the testing period must be corrected and a new test submitted for review prior to final approval. The CMC staff works directly with the submitter during all phases of the testing process. Test submissions should contain a cross section of claim type data that can be expected in a production environment. The test file must consist of a minimum of 10 claims for each claim type to be billed. A maximum of 100 claims are allowed for testing. The test procedure must be completed for each applicable claim type. A new test must be submitted when software is upgraded or the submission method changes.

Submitters may test status accurate file format, completeness and validity for HIPAA-related compliant claims transaction by logging into the Medi-Cal test site using their submitter ID and password, instructions for CMC testing can be found in the Testing and Activation Procedures section of the Medi-Cal CMC Billing and Technical Manual.

NOTE

Claims contained on the test file are not processed for payment. To test, submitters should use data from previously adjudicated claims. Submitters cannot send claims for adjudication until receiving written notification from the Department of Health Care Services (DHCS) stating they are in “active” status and are authorized for CMC billing.

http://files.medi-cal.ca.gov/pubsdoco/CTM_manual.asp


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Claim Timelines

Original (or initial) Medi-Cal claims must be received by the California Medicaid Management Information System (CA-MMIS) within six months following the month in which services were rendered. This requirement is referred to as the six-month billing limit. For example, if services are provided on April 15, the claim must be received by CA-MMIS prior to October 31 to avoid payment reduction or denial for late billing.

How to Dispute a Denial

Providers have three options for disputing claim denials:

Submit a new claim with corrected information if the dates of service are within the six month billing limit;

Submit an appeal within 90 days of the date on the RAD showing the claim denial;

Submit a Claim Inquiry Form (CIF) within six months of the date on the RAD showing

the claim denial.

For more information, providers should refer to Claim Submission and Timeliness Overview (claim sub) section of the Part 1 provider manual and the Appeal Form Completion (appeal form) and CIF Completion (cif co) section of the appropriate part 2 provider manual.

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Resource Information For questions or concerns:

Providers may request additional onsite or telephone support via the TSC at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Border providers and out-of-state billers billing for in-state providers call (916) 636-1200. Providers calling from outside of California call the Out-of-State Provider Unit at (916) 636-1960 from 8 a.m. to 5 p.m. Monday through Friday, except holidays.

For more information regarding CMC, providers may refer to the Medi-Cal CMC Billing and Technical Manual. For electronic claim submission questions, contact the TSC at 1-800-541-5555, select option “4” for the Technical Help Desk and option “2” for CMC.

All other questions for the NICU/PICU Code Conversion may be submitted via email to [email protected].

Additional Information

For additional information, providers may:

Visit the NICU/PICU Services section located on the HIPAA: Code Conversion page for Frequently Asked Questions (FAQs) and the Provider Readiness Checklist.

Refer to the NICU/PICU Services Code Conversion Crosswalks for a full description of HIPAA-compliant CPT national codes and modifiers.

Routinely check the Medi-Cal Update provider bulletins and Newsflash articles.

Routinely check the Medi-Cal Learning Portal (MLP) Provider Training Calendar for announcements of upcoming training and webinars developed specifically for NICU/PICU providers.

Complete the Medi-Cal Subscription Service (MCSS) Form to receive timely notifications related to NICU/PICU services

Watch for the Computer Based Training (CBT) posted to the MLP at (www.medi-cal.ca.gov/education.asp) after the code conversion implements.



mailto:[email protected]

http://www.medi-cal.ca.gov/default.asp

http://files.medi-cal.ca.gov/pubsdoco/hipaa/articles/FQHC_RHC_Code_Conversion_Crosswalk_25407.pdf

https://learn.medi-cal.ca.gov/Training/TrainingCalendar.aspx

http://www.medi-cal.ca.gov/education.asp

http://www.medi-cal.ca.gov/education.asp

NICU/PICU Services

June 2019 1

Appendix

Acronyms CA-MMIS California Medicaid Management Information System

CBT Computer-Based Training

CCS California Children’s Services

CIF Claims Inquiry Form

CMC Computer Media Claims

CMS Net Children’s Medical Services Network

CPAP Continuous Positive Airway Pressure

CPT Current Procedural Terminology

DHCS Department of Health Care Services

E&M Evaluation and Management

eSAR Electronic Service Authorization Request

FAQs Frequently Asked Questions

GHPP Genetically Handicapped Persons Program

HCPCS Healthcare Common Procedure Coding System

HIPAA Health Insurance Portability and Accountability Act

ISCD Integrated Systems of Care Division

MCSS Medi-Cal Subscription Service

MLP Medi-Cal Learning Portal

NICU Neonatal Intensive Care Unit

PEDI Provider Electronic Data Interchange

PICU Pediatric Intensive Care Unit

RAD Remittance Advice Details

SAR Service Authorization Request

SCC Special Care Center

SCG Service Code Grouping

TSC Telephone Service Center

Medi-Cal Provider Training...

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