2025 Subacute Care Program Updates
| Date: | June 18, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (Health Plan) |
| To: | Health Plan Skilled Nursing Facilities and Long-Term Care |
| Type: | Informational/Educational |
| Subject: | 2025 Subacute Care Program Updates |
| Business: | Medi-Cal Managed Care |
The Health Plan would like to share additional guidance related to the Subacute Care Program to support accurate billing and reimbursement.
Subacute care is a level of care for patients requiring more intensive nursing than traditional Skilled Nursing Facilities (SNFs), but not full acute hospital care. Services may be delivered by:
- Distinct-Part Nursing Facilities Level B (DP/NF-B), or
- Free-Standing Nursing Facilities Level B (FS/NF-B)
All facilities must have a contract with DHCS to bill Medi-Cal for subacute services.
Reimbursement & Billing
Per Diem Rates now include services previously billed FFS, such as:
- Respiratory therapy
- Oxygen & ventilators
- Feeding pumps
- Physical/Occupational/Speech therapy
- Audiology
- Intravenous therapy
- CPT 99000 and 99070 (no separate billing)
Lab, Radiology & Pathology (TC) services (CPT 70000–89999) are included in the per diem. Only the professional component (26 modifier) may be billed separately. CT, MRI, and MRA codes may require prior authorization.
Billing Codes Overview
NPI must be listed on the corresponding rate sheet.
Resources:
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
