Medi-Cal EWC Program Adds 15 Billable CPT/HCPCS Codes and Updates ICD-10-CM Diagnoses

Medi-Cal also announced October 9, 2026 that the California Every Woman Counts (EWC) program will add new procedure codes and updated diagnosis codes for covered breast and cervical cancer screening and diagnostic services to Medi-Cal's billing policies. The 15 new CPT and HCPCS codes are consistent with guidance from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and can be used by primary care providers (PCPs) and referral providers. All changes are retroactive and that means that a claim that was rejected before may be paid now. 

CPT Codes Added to the EWC Program Effective October 26, 2024

On October 26, 2024, the EWC program added seven more CPT codes to the reimbursable services list. Specific anesthesia, biopsy, tumour analysis and sedation services are included in these codes. The following codes have been covered for the first time: 

• CPT 00940: Anesthesia services for vaginal procedures, including biopsy of the labia, vagina, cervix, or endometrium, when no more specific classification applies.
• CPT 10009: Fine needle aspiration biopsy of the first lesion performed with CT imaging guidance.(add-on code, reported with 10009).
• CPT 10010: Fine needle aspiration biopsy of each additional lesion using CT guidance.
• CPT 38505: Needle biopsy of an axillary lymph node.
• CPT 88361: Computer-assisted morphometric analysis of tumor immunohistochemistry, reported per specimen.
• CPT 99156: Moderate sedation provided to patients aged five years or older, with a reported time range of 10–22 minutes.
• CPT 99157: Additional moderate sedation time reported for each subsequent 15-minute interval.

Seven CPT Codes Reimbursable Retroactively to October 26, 2024

The EWC program now reimburses CPT code 87626 retroactively for dates of service on or after January 1, 2025. This code is for nucleic acid testing performed for human papillomavirus (HPV) and the outcome is reported for individual high-risk HPV types and high-risk pooled results. 

• CPT 87626: Detection of HPV DNA or RNA, with separate reporting of high-risk types, such as 16, 18, 31, 45, 51, and 52, along with high-risk pooled results.

CPT and HCPCS Codes Added to the EWC Program

Starting January 1, 2026, the EWC program included six new tissue localization, cervical procedures, and contrast-agent administration CPT and HCPCS codes for reimbursement. The following services are added: 

• CPT 10035: Placement of a soft tissue localization device in the first lesion through a percutaneous approach, with imaging guidance.
• CPT 10036: Placement of a soft tissue localization device in each additional lesion, including imaging guidance.
• CPT 57460: Cervical colposcopy that includes biopsy of the cervix using a loop electrode.
• CPT 57461: Cervical colposcopy with loop electrode conization of the cervix.
• CPT 57520: Cervical conization performed using a cold knife or laser, with or without additional procedures such as fulguration or dilation and curettage.
• CPT 57522: Cervical conization performed using loop electrode excision, with or without additional procedures.
• HCPCS A9585: Gadobutrol injection which is reported per 0.1 mL.

ICD-10-CM Diagnosis Code Updates

For dates of service on or after October 1, 2023, the EWC program allows the following ICD-10-CM diagnosis codes as indications for breast cancer diagnosis when billing for covered services:

• R92.30
• R92.31
• R92.32
• R92.33
• R92.34

Cervical Cancer Screening and Diagnosis Codes Effective October 1, 2025

ICD-10-CM diagnosis code R10.2 will no longer be a permitted EWC diagnosis code for dates of service on or after 10/01/2025. These codes have been included as acceptable screen codes to use for cervical cancer screening and diagnosis: 

• R10.20
• R10.21
• R10.22
• R10.23
• R10.24

EWC Claim Reprocessing and Resubmission

Claims for dates of service through October 26, 2024, will be reprocessed automatically for those that are affected by an Erroneous Payment Correction (EPC). Providers may also submit previously denied claims to their provider for correction and resubmission in accordance with the CIF Submission and Timeliness Instructions section of the provider manual under the new billing policy. 

What This Means for Your Practice

• Pull denials for the 15 new codes with dates of service on or after each effective date, and watch upcoming RADs for EPC adjustments.
• The EPC is effective from 26 October 2024, but the R92.3x codes are effective from 1 October 2023. The bulletin does not indicate if the EPC will make up that deficit so it's best to resubmit those claims in a CIF. 
• Recode claims with dates of service on or after October 1, 2025 that were denied on R10.2 to the correct R10.20–R10.24 code, and resubmit.

Update EHR and charge master code sets so new EWC claims go out clean.

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Accurate billing for breast and cervical cancer screening and diagnostic services requires careful coding and claim management. BillingFreedom provides medical billing and coding services to help healthcare providers manage claims related to diagnostic procedures, screening services, and changing coding requirements. Our services support efficient billing workflows and accurate claim submission.

Contact BillingFreedom via email: info@billingfreedom.com to learn how our services can support your practice’s billing and coding requirements.

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Source: Medi-Cal, EWC Program Policy Updates: New Covered Procedure Codes and ICD-10-CM Diagnosis Codes, published October 9, 2026.