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Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394
Act
immediately
Effective date
May 20, 2026
Identified
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.
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What to do
immediately · 5 steps
01Billing 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.
02Update billing system to route these codes to institutional billing.
03For claims over $999,999.99, use multiple lines on UB-04/837I forms.
04Resubmit previously denied claims using correct form type.
05CMS-1500 submissions will be denied.
Codes mentioned
J3392J3394
Original notice
Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.