Provider Alerts

Medi-Cal Local Codes and Modifier ZS
HPSJ previously removed the ability for providers to bill Medi-Cal Local Codes and Modifier ZS, effective October 1, 2014, with the expectation that State Medi-Cal would be doing the same. That did not occur.

HPSJ realizes the difficulty that this has caused your practices and until further notice we have made the business decision to reinstate the Medi-Cal Local Codes and Modifier ZS.
Please be patient and bear with us once more, while we reinstate the Medi-Cal Local Codes (Z-Codes) and Modifier ZS.

Crosswalk Codes to Continue
HPSJ has also made the decision to continue to allow the crosswalk codes that were used in place of the Medi-Cal Local Codes, allowing you to bill with either the Medi-Cal Local Codes or CPT or HCPCS Codes.

Unlisted/Unspecified CPT Codes – REMINDER
To process claims more efficiently, as of October 1, 2014, HPSJ no longer accepts “99” Codes (codes ending in 99) also referred to as ‘By Report’ codes. Claims billed with “99” codes will be denied*.

The following is a list of the common 99 codes that are no longer accepted by HPSJ:
*Providers may bill the sales tax on taxable items (supplies and DME), utilizing Code S9999.
01999, 15999, 17999, 19499, 20999, 21199, 21999, 21499, 21899, 22899, 22999, 24999, 25999, 26499, 27299, 27499, 27599, 27899, 28299, 28899, 29799, 29899, 29999, 30999, 31299, 31599, 31899, 32999, 33999, 36299, 37799, 38999, 39499, 39599, 40799, 40899, 41599, 41899, 42299, 42699, 42999, 43499, 43999, 44799, 44899, 45499, 45999, 46999, 47399, 47999, 48999, 49999, 51999, 53899, 54699, 55899, 58999, 59899, 60699, 61799, 63199, 64999, 66999, 67299, 67399, 67599, 67999, 68399, 68899, 69399, 69799, 76499, 76999, 77299, 77399, 77499, 77799, 78099, 78199, 78299, 78399, 78499, 78599, 78699, 78799, 78999, 79999, 80199, 80299, 81099, 81299, 81599, 83499, 84999, 85999, 86999, 87298, 87799, 87899, 87999, 88099, 88199, 88299, 88399, 90390, 90899, 90999, 91299, 92499, 93299, 93799, 94799, 95199, 95999, 96999, 97799, 99199, 99499, A0999, A4399, A6199, A9599, A9699, A9999, B4199, B9999, C1899, C2699, C9399, C9899, D0999, D2799, D2999, D3999, D4999, D5899, D5999, D6199, D6999, D7899, D7999, D8999, D9999, E0199, E1399, E1699, E2399, E2599, G0399, G8399, G8699, G8899, G8999, G9099, G9199, G9299, J1599, J7199, J7599, J7690, J7799, J8499, J8999, J9999, K0899, L0999, L1499, L2999, L3999, L5699, L5999, L7499, L8499, L8699, Q0499, S0199, S5199, S8999, T1999, T5999, V2199, V2299, V2399, V2499, V2599, V2799, V5299, Z5299, Z5499, Z5999, Z8599.

“Please Note: Any and all unlisted CPT codes are not reimbursable. Billings must be submitted with the appropriate CPT or HCPCS Code.”

• NOTE: There are exceptions to some of the existing contracts that will continue to allow for payment on specific “99” Codes.

J-CODES REMINDER
Please use your reference materials to ensure you are billing with the most accurate code for the services rendered.

• Claims billed using the J3490 code, must be billed with the NDC number or they will be denied.

TO ASSIST YOU IN LOCATING THE CORRECT CODE FOR THE SERVICES YOU ARE PERFORMING:

• You can access the Code Finder option in DRE, our secure provider portal, to check on active codes and to identify if prior authorization is required or not.
• You also can call our Provider Services Department for assistance on possible crosswalk codes.

If you have any questions regarding these codes – Medi-Cal Local Codes and Modifier ZS, Crosswalk Codes, Unlisted/Unspecified CPT Codes, or J-Codes – please contact our Provider Services Department at (209) 942-6340.