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Quick ReferenceThe CCS Program Medical Eligibility and Medical NecessitySubjects Audiology – Hearing Services and Cochlear ImplantDental and OrthodonticsDurable Medical Equipment & Medical SuppliesEarly Periodic Screening, Diagnosis and Treatment – Supplemental ServicesHome Health Services & Pediatric Palliative Care Services and OptionsMedical Eligibility & Medical Necessity for Diagnostic Evaluations, Therapies, TreatmentsMedical Therapy Program & Medical Therapy s/Newborn – Diagnostic Services for InfantsProviders – Physicians, Centers, HospitalsCMS/CCS General Program Administration and Case Management PoliciesFiscal YearCMS/CCS policy and letters can be found in the following Website Links: CMS Information NoticesCCS Information NoticesCCS Numbered LettersCHDP Information NoticesCHDP Program Letters and Provider Information NoticesGHPP Provider LettersGHPP Client LettersHCP Program LettersHRIF Program LettersNHSP Program Letters and Information NoticesRN’s Quick Reference Policy List - Updated 9/15/14jg
AUDIOLOGY – HEARING SERVICES and COCHLEAR TLEBone Anchored Hearing Aids (BAHA) (Supersedes 03-0207) - 060413Authorization of Diagnostic Audiology and Treatment Services for Child with Hearing Loss.Note: this letter supersedes 21-1299Cochlear Implant Updated Candidacy Criteria and Authorization Procedures.Note: this letter supplements 03-0411Note: 10-1211 supersedes 09-1208Cochlear Implant Post Surgery Services.Note: this letter supplements 09-1208Genetics Evaluation for Children with Hearing LossHearing Aids.Note: this letter supplements 12-0605Note: 07-1011 supersedes 30-1205Cochlear Implants.Note: this letter supplements 09-1208)Note: this letter supersedes 02-0796Cochlear Implant Batteries & Parts (Supplements 13-1106)Note: this letter supersedes 12-1007 & 09-0900Update and Clarification of Policy related to the Authorization of Frequency Modulation (FM) Systems orAssistive Learning DevicesNote: this letter supplements 13-0605Cochlear Implants.Note: this letter supplements 03-0411Note: this letter supersedes 09-0900 & 02-0796Reporting to the New Hearing Coordination Center Contractor for the NHSP in the Northeastern and CentralCalifornia RegionCochlear Implant Batteries & Parts (includes CI Replacement Parts & Batteries Request Form). Note: thisletter supplements 09-0900.Hearing Aid Supplies and MaintenanceBone Anchored Hearing Aids (BAHA) and BAHA Request FormCochlear Implant Speech Processor UpgradesUpdate to Medi-Cal Approved Centers of Excellence for Cochlear Implants Providing Services for CCSEligible Beneficiaries Note: see also 14-1003Benefits for Hearing Aid Maintenance: Batteries, Accessories, Earmolds, Repair/Modifications. Note: thisletter supplements 10-1208Note: this letter supersedes 13-0497Delegation of Authority for Authorization of Assistive Listening Devices to County CCS Programs & CMSRegional Offices & Request for Hearing Aids & Assistive Listening DevicesDelegation of Authority for Authorization of Hearing Aids Previously Reviewed as “Non-ConventionalHearing Aids” to County CCS Programs and CMS Regional Offices and Request for Hearing Aids andAssistive Learning DevicesDelegation of Authority for Authorization for Aural Rehabilitation Services to County CCS Programs andCMS Regional Offices & Medi-Cal Certified Outpatient Rehabilitation Centers.Purchase and Utilization of Loss and Damage (L&D) Insurance for Hearing Aids, Cochlear ImplantsProcessors, or Alternative Listening Devices for CCS Case-Managed BeneficiariesAdditional M/C Approved Center of Excellence for Cochlear Implant Providing Services for CCS EligibleBeneficiaries. Note: this letter supplements 09-0900Authorization of Audiology ServicesNon-Conventional Hearing AidsNote: this letter superseded by 12-0605 and 07-1011SUPERSEDED by 02-0411 Cochlear Implants (09-0900 superseded 02-0796)SUPERSEDED by 11-1211 Authorization of Services for Children with Hearing LossRequest for Audiology ServicesCommunication Disorder Center StandardsCCS Audiology Program ConsultantCommunication Devices. Note: this letter revised 14-0590 and 40-1290Otology and Audiology ServicesBack to top
DENTAL and NL*NL*NL*NL*NL*TITLEDental Implant Requests (Supersedes 16-0899) - 093013Changes in CCS Dental and Orthodontic Service Authorizations and Claims Processing (addresses CCS/HFonly and full scope M/C no SOC)Note: this letter supersedes 07-0395CCS/GHPP Rate Increase for Dental ServicesNote: this letter is the corrected versionBy-Report Dental Procedures Reimbursement FeesNote: this letter supersedes 11-0291Dental Benefits for CCS Clients Note: the enclosures are not available onlineDenti-Cal Bulletin and Processing of Denti-Cal Claims for CCS/Full Scope, No Share of Cost Medi-CalBeneficiaries Case Managed and Services Authorized by the CCS ProgramMalocclusionCase Management & Payment for Orthodontic Care of Cleft Palate Patients who Lose M/C EligCCS Orthodontic ProgramIncrease in Dental RatesCCS Advisory Orthodontic CommitteeOrthodontiaExtended Treatment Visits for Orthodontic CareOrthodontic Services and additional informationDental Services SMABack to topDURABLE MEDICAL EQUIPMENT & accessories; and MEDICAL SUPPLIESNUMBERTYPE01-0111NL07-09NL05-0910-0707CCS INNL02-010718-060503-1207-100409-0703NLNLCCS orization of Insulin Infusion PumpsNote: this letter supersedes N.L. 08-0799 Continuous Insulin Pump TherapyReplacement Page for 2003 CCS Guidelines for Recommendation and Authorization for Rental orPurchases of DME-R and Replacement for Page 10Addition to DME-Rehabilitation (DME-R) Guidelines & Criteria for Basic W/C (Manual & Power)Revised Guidelines for Authorization of Oxygen, O2 Delivery Equipment, & Related SuppliesNoted: this letter supersedes 01-0107 and 47-1191; (12-0490?)Authorization of Rental of Portable Home VentilatorsNationwide Recall of VAIL Enclosed Bed Systems and FDA Notice to PublicIncontinence Medical Supplies. Note: this IN supplements 08-0703HCPCS Code Changes eff: 11/2004 for DME and Diabetic SuppliesRevised CCS Guidelines for Recommendation and Authorization of Rental or Purchase of MedicalEquipment-Rehabilitation (DME-R). Note: this letter supersedes N.L. 08-0291 and 23-0793Authorization for Purchase of Incontinent Medical Supplies (IMS)Note: this letter is the corrected version; this letter supersedes N.L. 06-0492Pulse Oximeters. Note: this letter supersedes N.L. 01-0191Synthesized Speech Augmentative Communication (SSAC) Devices (formerly known as ACCs)Note: this letter supersedes N.L. 05-0397Automobile Orthopedic Positioning Devices (AOPDS)Authorization of Flutter Valves and ThAIRapy VestsMedical SuppliesGuidelines for Durable Medical Equipment Recommendations for PurchaseDurable Medical Equipment (DME)Payment for Repairs to DME Not Originally Purchased by CCS Also see: 13-0388Continuous Passive MotionDurable Medical EquipmentRental vs. Purchase of Durable Medical EquipmentApnea Monitors and Pneumograms; Home Patient Monitoring KitUpdate & Clarification of 39-1182: M/C Coverage of Cotton, Adhesive Tapes, Elastic BandagesBack to top
EARLY PERIODIC SCREENING, DIAGNOSIS and TREATMENT – SUPPLEMENTAL tion of Radiology Services as Early Periodic Screening Diagnosis and Treatment –Supplemental Services (EPSDT-SS)Delegation of Authority to Authorize EPSDT-SS to County CCS Programs and CMS Regional Offices,EPSDT-SS Worksheet, EPSDT-SS Worksheet Instructions, and Notice of Action (NOA) and First LevelAppeal Decision LetterBack to topHOME HEALTH SERVICES and PALLIATIVE CARE OPTIONSNUMBERTYPE01-0114NL12-04CMS IN12-BCHDP IN10-02CMS IN09-0306-1011CCS NL*NL*NL*TITLEEarly and Periodic Screening, Diagnosis, and Treatment - Private Duty Nursing and Pediatric Day HealthCare, Treatment Authorization Requests and Services Authorization Requests - 011514Transition of Children and Adolescents Who are Healthy Families Program Subscribers to Medi-Cal 122012New CHDP Program Resource: Pacific Islander Teen Health Spa Curriculum, Healthy Beautiful (anobesity prevention program for teen girls) - 040212Web Source for the Title V Children with Special Health Care Needs (CSHCN) Needs Assessment Report- 061513Updated List of Liaisons for Healthy Families (HF) Program Health Plans and Local CCS ProgramsAuthorization of Medically Necessary Concurrent Treatment Services for CCS Clients who Elect HospiceCareUnique CCS Aid Codes for Children Participating in the Pediatric Palliative Care Waiver (PPCW)Policy Relating to CCS Nurse Liaison Position in Partners for Children (Pediatric Palliative Care WaiverProgram)Authorization of Short-Term Shift Nursing Services and HCPCS Codes for Short-Term Shift NursingServicesPalliative Care Options for CCS Eligible Children and Codes Available for Authorization of PediatricPalliative Care ServicesIntermittent Home Health Services Provided by a Home Health Agency (HHA) and Services Allowances(Time) per Visit ListSupplemental Nursing Services. See also: 02-0189Nursing Services in the Home.See also: 11-0489Home Health Agency ServicesHome Care and Case Management GuidelinesRespite Care and the Level of Care Providers Who May Be Authorized by CCSMedi-Cal In-Home Medical Care (IHMC) Program; CCS In-Home Nursing ProgramBack to topMEDICAL ELIGIBILITY & MEDICAL NECESSITY for Diagnostic Evaluations, Treatments & TherapiesNUMBERTYPE04-0511NL02-050109-03NLCMS IN09-02CMS IN10-0707NL08-0507NLTITLENeonatal Intensive Care Unit (NICU) AuthorizationsNote: this letter supersedes 03-0206Service Code Grouping (SCG) 51 ImplementationCCS, CHDP, NHSP and GHPP LawsNote: update to set of laws previously provided in CMS I.N. 05-08, 01-07, 96-7. See also:NL 50-1294* CCS Program Benefit RegulationsNL 01-0194* CCS LawsNL 43-1091* CCS Laws, 1991 Legislative SessionNL 27-0791* CCS LawsNL 23-0791* New State LawsNL 24-0889* CCS LawsNL 49-1184* LegislationNL 33-0883* CCS LawsUpdated CCS Program Regulations - Changes reflect renumbering of the regulations and nonsubstantive changes in language.Note: this letter supplements CCS Medical Eligibility Regulations: 05-0500, 06-0599Revised Guidelines for Authorization of Oxygen, O2 Delivery Equipment; Related SuppliesNote: this letter supersedes 01-0107 and 47-1191Vagal Nerve Stimulator (VNS) Implantation
8616-078605-0286NL*NL*NL*NL*NL*NL*Authorization of Emergency Services Related to TraumaNote: this letter details policy re: authorizations to non-paneled physiciansHigh Risk Infant Follow-Up (HRIF) Program ServicesNote: this letter supersedes 06-0403 and 09-0902Neonatal Intensive Care Unit (NICU) AuthorizationsSpeech Pathology Services & Medi-Cal Certified Outpatient Rehabilitation CentersAuthorization of Occupational Therapy (OT) Services & Medi-Cal Certified OTPT Rehab Centers (OPRC)Medical Eligibility Nephrotic SyndromeAuthorization for Purchase of Incontinent Medical Supplies (IMS)Note: this letter is the corrected version and supersedes 06-0492Injuries to Joints and Tendons Policy ClarificationNote: this letter supersedes 08-0501Outpatient Mental Health Services as CCS BenefitsMedical Eligibility for Care in a CCS-Approved Neonatal Intensive Care Unit (NICU)Note: this letter is the corrected version and supersedes N.L. 11-0999Children at Risk for Human Immunodeficiency Virus (HIV) InfectionNote: this letter supersedes 01-0105 and 12-0701Kawasaki DiseaseCCS Medical Eligibility RegulationsNote: this letter supersedes 06-0599. Note: this letter supplemented by CMS IN 09-02Indicators for Social Work & Psychologists Services for CCS/GHPP ClientsNote: this letter supersedes 14-1099 and 02-0299New Medical Treatment Modalities/Interventions which are not Established CCS BenefitsAuthorization of Flutter Valves and TheAIRpy VestsMedical Eligibility for the Children with Proven HIV InfectionOrgan Transplants – Heart, Liver, Bone Marrow, Lung and Heart-LungNote: this letter supersedes 08-0394Lung and Heart-Lung TransplantsBone Marrow Transplants for Cancer, Section 273, H&SCGuidelines for Diagnosis and Treatment of Lead PoisoningNote: this letter supersedes 09-0592Coverage of Experimental and/or Investigational ServicesChronic Lung Disease of InfancyLuconex BAC Wheelchair/Mobile StanderDNA Probes for Hemophilia, Cystic Fibrosis, Sickle Cell, Phenylketonuria. See also: 32-0990. Note:this letter is regarding Genetic Testing (Carrier and Prenatal Testing)Heart TransplantsCCS Program Coverage of Women for AFP TestingEmergency Regulations for HIV ScreeningOrgan Transplants – Heart, Liver, Bone MarrowLiposuctionSelective Posterior Rhizotomy (SPR)Occupational Therapy for Swallowing and/or Feeding Problems in Patients with CCS Eligible Conditions.Note: this letter supersedes 03-0189Liver Transplant: Global Physician Service ReimbursementExtracorporeal Membrane Oxygenation (ECMO)Magnetic Resonance Imaging (MRI)EpikeratophakiaMagnetic Resonance Imaging (MRI) UpdateMagnetic Resonance Imaging (MRI)Clarification of CCS Eligibility for GE RefluxClarification of CCS Eligibility for GE RefluxEye Prostheses (eye appliances)CCS Services to Children Who Live In Intermediate Care Facilities for the Developmentally Disabled.Note: see also 32-0784AIDSScoliosis: Lateral Electrical Surface Stimulation (LESS).Also see: 17-0785, 37-0983, 11-0383Diseases of the NewbornAngioplasty or Therapeutic Cardiac Catheterizations (TCC)EpilepsyDiabetes MellitusMedical AIR Ambulance TransportationEye
1-058341-1182NL*NL*NL*NL*NL*NL*NL*NL*NL*Neural Tube Defects Compared with Other Birth DefectsHeart TransplantsBone Marrow Transplantation for CancerLiver TransplantsArtificial Eyes: CCS Coverage and Maximum AllowancesNew Hemophilia Treatment ProductsCCS/GHPP Cystic Fibrosis Treatment BenefitsPrenatal Diagnosis of Sickle Cell DiseaseDiagnostic Use of Pneumograms; Requirements for Approval of Apnea Monitors for Home UseBack to topMEDICAL THERAPY PROGRAM (MTP) and Medical Therapy Unit *NL*NL*NL*NL*NL*08-0389NL*TITLEPowered Mobility Devices (PMD)Implementation of Updated Tools for Classification of Function and Measurement of Functional Outcomes inthe Medical Therapy Programementation of the Episodic Treatment Method (ETM) as an Alternative Therapy Provision Method (ATPM) inthe Medical Therapy Program (MTP)Participation in the CCS Medical Therapy Program (MTP) Medical Therapy Conference (MTC) by CCSProgram Medical Directors and Medical ConsultantsRevised Implementation Plan for the Quarterly Time Study (QTS) for MTP for 100 Percent State-Funding toComply with IA Regulations (AB 3632)Functional Outcome Measurement for the MTPDependent and Independent County CCS MTP Guidelines for Development of Policies and Procedures forImplementation of HIPPARESCINDED MTP Reimbursement for HF clients MTP OPRCNotice of Privacy Practices for CCS MTP; Compliance with HIPPAReimbursement of LEA or SELPA for Provision of Medically Necessary Therapy Services to ChildrenMedically Eligible for CCS/Medical Therapy Program (MTP)Synthesized Speech Augmentative Communication (SSAC) Devices (Formerly known asAugmentative/Alternative Communicatoin (AAC) Devices).Note: this letter supersedes 05-0397Revised Interagency Agreement (IAA) Between the CMS Branch and the California Department ofEducation (CDE), Special Education Division (SED)Instructions for Completion of the “State Approved 100% State Funded Staff Allocations for County MTP”formDuplication of Physician or Therapy Services provided through CCS/MTPNote: does this letter supersede 06-0600Duplication of Physician or Therapy Services provided through CCS MTPCCS MTP List. (The enclosure is not available online.)The MTP: Dispute Resolution through “Expert “ PhysicianDesignation of a New Identifier to Capture Costs Related to the MTPVendored Therapy SitesDesignation of Code 50 on Form MC 255B to Represent Vendored Therapy in Lieu of MTUDetermination of Medical Eligibility for the Medical Therapy Unit (MTU)Vendored Physical Therapy and Occupational Therapy RatesMTUs and Due ProcessDetermination of Medical Eligibility for Medical Therapy Program Services. See also: 39-1290 Medical Eligibility for the Medical Therapy Program 03-0788 Medical Eligibility for MTP 03-0288 Medical Eligibility for MTPProgram Advisory from Dept. of Education on Occupational Therapy and Physical TherapyOregon Orthotic SystemVendored Therapy Rates for Services in Lieu of MTU ServicesNotification of Due Process Hearings for Special EducationResponsibility for Local MTU Services for Out-of-County Residents Enrolled in Public SchoolsCounty Responsibility for MTU Services for Children Enrolled in Public Schools in the CountyPayment for Occupational Therapy and Physical Therapy Services in Lieu of MTU ServicesProvision of Medical Therapy Unit (MTU) Services Including Physical Therapy/Occupational TherapyConsultation Outside the MTUNote: does this letter supersede 11-0288?Revised Procedure for Coding Cerebral Palsy on CCS Forms
Revised Procedure for Coding Cerebral Palsy on CCS FormCCS Physical Therapy and Occupational Therapy Services to Home-Bound ChildrenCCS-MTU (Therapy) Services to Children Residing in ICF-DDsProsthetic and Orthotic SMA Effective 9/26/84Changes in Recording of PT and OT Services and Related InformationICF-DD and ICF-DD-H (MTU letter)CCS Services and Children who are covered by Medi-Cal and Live in ICF-DD FacilitiesCCS-MTU Services to Children Residing in ICF-DDsPayment for Contract Therapists at a Medical Therapy Unit (MTU)Additions to the Prosthetic and Orthotic Appliances SMABack to topPHARMACY – S INCCS INCCS INCCS INNLTITLEDrugs Classified Drug Efficacy Study Implementation – release date 031414Unauthorized Manufacturer Labeler Codes Not Payable - 031414Prescriptions Containing Acetaminophen Limited to 325MG Per Dosage Unit - 011714Diagnosis Related Group Inpatient Reimbursement and Hemophilia Factor Drugs - 111413Palivizumab (Synagis ) (Supersedes 04-0509) Note: Information Notice 13-05 is related - 01101311/18/1001-0510CCS INNL09-0504-0509CMS INNL01-01095/3/07NLCMS -0393CCS INNL*NL*NL*05-0191NL*01-019016-0889NL*NL*Notice from CCS About Prescription Drug Coverage and Medicare (See other annual notices)BOTOX (Botulinum Toxin)Note: this letter supersedes N.L. 07-0407Contracting for FACTOR Products Begins July 1, 2009SYNAGIS (Palivizumab)Note: this
Reporting to the New Hearing Coordination Center Contractor for the NHSP in the Northeastern and Central California Region 12-1007 NL Cochlear Implant Batteries & Parts (includes CI Replacement Parts & Batteries R
