Are condoms still covered by Medi-Cal?
Condoms and diaphragms will remain a benefit, however as directed per the December 2008 Provider Bulletin (#694), the billing mechanism has changed. Effective for dates of service on or after March 1, 2009, the Maximum Allowable Product Cost (MAPC) has been established for condoms and diaphragms billed to the Medi-Cal fee-for-service program. In addition, these items will be limited to pharmacy providers only and will be billed using the 11-digit National Drug Code (NDC) or the 11-digit Universal Product Number (UPN). The following medical supply Healthcare Common Procedure Coding System (HCPCS) Level III local codes will be end-dated on the same date, for all manufacturers: 9914A, 9914P, 9925A, 9925B, 9925C, 9925D, 9925E and 9925F. • Pharmaceuticals are currently billed on the National Council for Prescription Drug Programs (NCPDP) 1.1 batch format and 5.1 online format. How will the new billing requirements affect pharmacy billing? A: Pharmacy Billing requirements and formats, includ
