MedicaidAdministrativeHigh impact
Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394
Medi-Cal·CA · Hematology, Oncology·Claims & Billing
Effective date
May 20, 2026
We identified it
May 24, 2026
Summary
For Medi-Cal's Cell and Gene Therapy Access Model, providers must now use UB-04 claim forms (or 837I electronic) instead of CMS-1500 forms when billing HCPCS codes J3392 (Casgevy) and J3394 (Lyfgenia) for sickle cell disease treatment. Claims submitted on CMS-1500 forms will be denied.
Action Required
Immediately: Billing team must switch from CMS-1500 to UB-04 claim forms (or 837I electronic) when billing HCPCS codes J3392 and J3394 for sickle cell disease under Medi-Cal CGT Access Model. Update billing system to route these codes to institutional billing. For claims over $999,999.99, use multiple lines on UB-04/837I forms. Resubmit previously denied claims using correct form type. CMS-1500 submissions will be denied.