J code Medications – Carved-Out to Fee-for-Service (FFS) Medi-Cal
| To: | Health Plan of San Joaquin (HPSJ) Providers and Hospitals |
| From: | Provider Services Department |
| Subject: | J code Medications – Carved-Out to Fee-for-Service (FFS) Medi-Cal |
| Business: | Medi-Cal, AIM (now known as Medi-Cal Access Program) |
Effective July 14, 2016.
Certain J code medications are carved-out and should be billed directly to FFS Medi-Cal. In order to determine if a specific medication is carved-out, please visit HPSJ’s online provider portal (DRE) and use the Code Search Tool to determine benefit coverage.
Medications that are carved-out and billed to HPSJ will be denied (regardless of place of service).
Members will still be able to receive the carved-out services from providers. However, the claim will need to be billed to FFS Medi-Cal.
If you have any further questions, please contact our Provider Services Department at (209) 942-6340.