UPDATE – Changes to Proposition 56: Family Planning Services (All Plan Letter 22-011)
| Date: | October 3, 2022 |
| To: | HPSJ Contracted Providers |
| From: | Health Plan of San Joaquin (HPSJ) |
| Subject: | UPDATE – Changes to Proposition 56: Family Planning Services (All Plan Letter 22-011) |
| Business: | Medi-Cal |
The following summarizes the Department of Health Care Services (DHCS) All Plan Letter 22-011, which outlines changes to the Proposition 56: Family Planning Services directed payments program:
| Item | CPT Code | Description | Uniform Dollar Add – on Ammount | Change |
| A | J7294 | CONTRACEPTIVE VAGINAL RING: SEGESTERONE ACETATE AND ETHINYL ESTRADIOL | $301.00 | Active beginning 1/1/22 |
| B | J7295 | CONTRACEPTIVE VAGINAL RING: ETHINYL ESTRADIOL AND ETONOGESTREL | $301.00 | Active beginning 1/1/22 |
| C | J7304U1 | CONTRACEPTIVE PATCH: NORELGESTROMIN AND ETHINYL ESTRADIOL | $110.00 | Active beginning 1/1/22 |
| D | J7304U2 | CONTRACEPTIVE PATCH: LEVONORGESTREL AND ETHINYL ESTRADIOL | $110.00 | Active beginning 1/1/22 |
| E | J7303 | CONTRACEPTIVE VAGINAL RING | $301.00 | Inactive after 12/31/21 |
| F | J7304 | CONTRACEPTIVE PATCH | $110.00 | Inactive after 12/31/22 |
| G | 58555 | HYSTEROSCOPY DX SEP PROC | $322.00 | Inactive after 12/31/19 |
| H | 58565 | HYSTEROSCOPY STERILIZATION | $1,476.00 | Inactive after 12/31/19 |
HPSJ is working to configure the above indicated changes in its payment system. This may result in a delayed payment as we are working through this change. HPSJ contracted providers do not need to do anything different than send clean claims timely. For codes that were retroactively identified by DHCS as “inactive”, HPSJ will be evaluating approaches to minimizing any negative impacts on our eligible providers.
As stated in the HPSJ Provider Manual, timely filing guidelines for claims submission is three hundred and sixty-five (365) days from the date of service. If a claim is received after the appropriate time frame, the claim will be denied unless disputed pursuant to C.C.R. Section 1300.71.38 and a good cause for delay as defined can be presented. For more information, please review Section 10 of the HPSJ Provider Manual (https://www.hpsj.com/provider-manual/).
If you have further questions about the VBP program –– please contact the HPSJ Claims Department via the email address: SupplementalPayments@HPSJ.com. Please allow two business days for a response.
Thank you for your continued support of Health Plan of San Joaquin. You may also visit https://www.hpsj.com/alerts/ for online access to this document and additional provider alerts previously shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.