Public Comment Forum: Adult Day Health Care Billing Code Modifications…

Public Comment Forum: Adult Day Health Care Billing Code Modifications
Effective for dates of service on or after December 1, 2008, the Department of Health Care Services (DHCS)
will discontinue the use of the current Medi-Cal interim codes related to Adult Day Health Care (ADHC)
services. These interim codes will be replaced by Healthcare Common Procedure Coding System (HCPCS)
Level II codes in combination with the National Uniform Billing Committee (NUBC) Revenue Codes to be in
compliance with provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996,
Public Law 104-191, 45 CFR 162.1000. This article also provides information about a public comment period
regarding these changes.
Providers must not bill the new coding standards until they are instructed to do so in future Medi-Cal
Updates.
The following changes will be made at the time the national codes are implemented:

Current Billing Codes/Reimbursement                 New Billing Codes/Reimbursement
Interim                                          National
           Description            Rate                            Description                         Rate
Code                                             Code

Z8500       ADHC Regular Day of        $76.22    Revenue             Adult day care, medical and     $76.22
            Service                              Code: 3103          social, daily
                                                 with
                                                 HCPCS: S5102        Day care services, adult; per
                                                                     diem


Z8502       ADHC initial               $80.03    Revenue             Adult day care, medical and     $80.03
            assessment day with                  Code: 3103          social, daily
            subsequent attendance                with
            at the center                        HCPCS: H2000        Comprehensive
                                                                     multidisciplinary evaluation


Z8504       ADHC initial               $80.03    Revenue             Adult day care, medical and     $80.03
            assessment day without               Code: 3103          social, daily
            subsequent attendance at             with
            the center                           HCPCS: H2000        Comprehensive
                                                                     multidisciplinary evaluation


Z8506       ADHC transition day        $64.79    Revenue             Adult day care, medical and     $64.79
                                                 Code: 3103          social, daily
                                                 with
                                                 HCPCS: T1023        Screening to determine the
                                                                     appropriate consideration of
                                                                     an individual for
                                                                     participation in a specified
                                                                     program, project, or
                                                                     treatment protocol, per
                                                                     encounter
Note: Interim codes Z8502 and Z8504 were collapsed into one new coding strategy (Revenue Code 3101 with
      HCPCS H2000; see above). Effective for dates of service on or after December 1, 2008, providers no
      longer need to differentiate between an ADHC initial assessment day with or without subsequent
      attendance at the center.
Public Comment Period
Notice is hereby given that DHCS will conduct written public proceedings where any interested person or
authorized representatives may present statement, arguments or contentions relevant to the action described in
this notice.
Any written statements, arguments or contentions (hereafter referred to as "comments") must be received by
DHCS during the public comment period beginning September 1, 2008 and through September 30, 2008, which
is designated as the close of the written comment period. The following section provides instructions for
submitting written comments to DHCS.
All comments, including e-mail, mail or fax transmissions, must include the author's name, organization or
affiliation, and telephone number.
Comment Instructions
To view the proposed changes, click the Public Comment Forum: Adult Day Health Care Billing Code
Modifications link in the Newsroom area of the Medi-Cal Web site home page
(www.medi-cal.ca.gov). This link will direct providers to the "Medi-Cal Comment Forum" where they can
view the article in PDF format by clicking the link in the "Current Topics" area. There are e-mail links provided
on the "Medi-Cal Comment Forum" page categorized by "Provider," "Health Plan" and "General Public" so
that comments may be e-mailed to Medi-Cal by clicking the associated link.
Note:    E-mail is not confidential. Caution should be used when entering confidential or sensitive information.
         E-mail addresses will not be shared with any outside parties, but may be used for future DHCS
         mailings.
Comments can also be submitted by mail or fax to:
    HIPAA Project Office ­ Adult Day Health Care Codes
    Medi-Cal Fiscal Intermediary
    PO Box 13811
    Sacramento, CA 95853
    Fax: (916) 638-8976 - Attn: HIPAA Project Team
For your comments to be processed, the following must be included in the e-mail, fax or mail correspondence:
    · Name
    · Organization or affiliation
    · Telephone number

Health plans are encouraged to consolidate their comments and forward them to DHCS through their designated
HIPAA contact person.