Procedure Rate Refresh

CalMHSA conducted a procedure rate refresh in county production environments this week, as follows: 

• FY 2024-25 rate refresh occurred Tuesday, Feb.3.  

• FY 2025-26 rate refresh occurred Wednesday, Feb. 4.  

What’s Not Included in This Rate Refresh 
This refresh does not include the most recent DHCS Outpatient Fee Schedule updates published in January. Those changes will be included in a subsequent rate refresh. 

  
What Is Included 
1. New NDC Code Records 
Rates were created for the new NDC codes published by DHCS as of July 1, 2025. 

• The complete list of NDCs is available in the MAT Codes as of 07‑11‑2025 tab within the Procedure Code Definitions spreadsheet on CalMHSA’s website. 

2. Claim Unit Updates
   All NDC codes now have a claim unit of 1 to prevent billing for more than one unit, reducing claim rejections. 

3. Corrections and Modifier Updates

• HQ Modifier Fix: The HQ modifier was incorrectly appended to some plan‑level rates for 90853 and 90849. This has been corrected. 

• HV Modifier Fix: The HV modifier will no longer be appended to H0025 or H0038, as it is not allowable for these procedures. 

• SC Modifier Removal for G0396/G0397: Some plan-level rates incorrectly included SC + 93 or SC + 95 modifiers. Per DHCS, only 93 or 95 should be used for these procedures when performing telehealth services. CalMHSA has aligned the refresh accordingly, and DHCS will remove SC from allowed modifiers for these codes in a future Service Tables update. 

External Referral Global Code Update 

As we work with some counties for their audit preparations, the need for additional referral reason options beyond the NSMHS code has come to light. On Feb. 6, we will add the following codes:

• MCP MH Referral (Screening Tool): To indicate that the referral was sent based on the screen tool 

• MCP MH Referral (Transition – Step Down): To indicate that the referral was sent using the Transition of Care tool and the client was fully stepping down from SMHS to NSMHS 

• MCP MH Referral (Transition – Nonduplicative Service): To indicate that the referral was sent using the Transition of Care tool and the client is being referred for additional services and will retain SMHS 

The NSMHS code will remain active during the transition to these new codes, as there are likely external referrals in progress that use the NSMHS code. The NSMHS code will be deactivated on March 6.  

Disabling No Show (My Office) Report 

System administrators received an email about this report being nonfunctional, and CalMHSA has received feedback from counties that it should be removed. The report will be deleted on Feb. 6. 

ASCMI Workflows Webinar Materials To Be Sent This Week 

CalMHSA’s second webinar in the Ask Me About ASCMI series for SmartCare workflows was held Feb. 4. The meeting recording and slides will be sent to all registrants by the end of this week; any ASCMI-related questions can be submitted to [email protected]. 

Recodes

Counties can add an end date to CalMHSA-created recodes, effectively “deactivating” them. 

New Workgroup Postponed Until Summer

Due to competing priorities, CalMHSA has postponed plans to form a Group Services County Workgroup. We will revisit this potential new group in July.