The 2006 updates to the Current Procedural Terminology, Fourth Edition, (CPT-4) and Healthcare Common Procedure Coding System (HCPCS) Level II codes become effective for Medicare on January 01, 2006. The Medi-Cal program has not yet adopted the 2006 updates. Do not use 2006 codes to bill for Medi-Cal services until notified to do so in a future Medi-Cal Update.
The following HCPCS Level II laboratory procedure codes are Medi-Cal benefits: HCPCS Code Description Q0111 Wet mounts, including preparations of vaginal, cervical or skin specimens Q0112 All potassium hydroxide (KOH) preparations Q0113 Pinworm examinations...
Interim HCPCS codes X0700 (portable X-ray, two patients) and X0702 (portable X-ray, three or more patients) will no longer be reimbursable. Providers should use national HCPCS codes R0070 (transportation of portable X-ray equipment and personnel to home or nursing home, per trip to facility or location; one patient seen) or R0075 (…more than one patient seen, per patient) when billing for...
To clarify current Medi-Cal billing policy on cystic fibrosis screening procedures, providers are reminded that CPT-4 codes 83890, 83891, 83892, 83893, 83894, 83896, 83897, 83898, 83901, 83904 and 83912 are used to bill for molecular diagnostic techniques for various clinical purposes. Additionally, the following billing policy applies for these codes: When used to bill for the...
Claims for CPT-4 code 87621 billed by Family PACT providers without the primary “S” diagnosis code and were denied for an incorrect diagnosis code need to be resubmitted by those providers with an appropriate primary diagnosis “S” code as well as one of the ICD-9 codes in order to be reimbursed.
Providers are reminded to use ICD-9 code V26.31 when billing a combination of the following codes up to a maximum quantity of 25 or up to a maximum reimbursement of $180 per day per recipient. CPT-4 Code Description 83890 Molecular diagnostics; molecular isolation or extraction 83891 isolation or extraction...
Retroactive to dates of service on or after January 05, 2004, laboratory services are subject to frequency limits. These limits are set per recipient, per service, per month via the Laboratory Services Reservation System (LSRS). The claim must be billed with the provider number used to make the reservation. Frequency limits may be overridden when the provider submits medical justification to...
Effective for dates of service on or after August 01, 2006, Family PACT (Planning, Access, Care and Treatment) is implementing diagnosis and procedure code changes. Medi-Cal Update Bulletin 384, contains a correction to lab procedures in the Family PACT Clinical Services Benefit published in Update Bulletin 283 (June 2006). Restrictions The following pathology CPT-4 codes are...
Effective retroactively for dates of service on or after November 1, 2005, CPT-4 code 88182 (flow cytometry, cell cycle or DNA analysis) is added as a Medi-Cal benefit. Also effective retroactively for dates of service on or after November 1, 2005, the following flow cytometry codes have been assigned specific prices. Codes 88184 and 88145 must be billed with modifier -TC (technical component)....
Effective retroactively for dates of service on or after November 01, 2005, CPT-4 codes 88367 and 88368 are Medi-Cal benefits. Also for the same dates of service, codes 88360, 88361, 88367 and 88368 have been assigned a specific price. No action is required on the part of providers. Claims submitted with these codes for dates of service beyond the six-month billing limit must include delay reason...
A frequent cause of claim denials by Medi-Cal is due to incorrect recipient admission and discharge dates and/or incorrect patient status codes as submitted by providers. Erroneous “from-through” dates or patient status billed by one provider and paid by Medi–Cal can result in the denial of correct claims billed by another provider. This often occurs between hospitals and nursing homes during the...
Effective for dates of service on or after September 01, 2006, reimbursement of CPT-4 code 80055 (obstetric panel) is restricted to once in nine months for the same provider. The provider may be reimbursed for a second or subsequent obstetric panel within the nine-month period if there is documentation to justify medical necessity or documentation of a different pregnancy.
Beginning September 2006, Medi–Cal providers will be able to register their National Provider Identifier (NPI) with the California Department of Health Services (CDHS) through an automated collection system. A new NPI Web page will appear on the Medi-Cal Web site that will contain the link to the NPI registration tool. HIPAA mandates the use of an NPI beginning May 23, 2007. Providers can...
Payment Reduction Reversed for Select Genetic Disease Lab Panels The 5 percent payment reduction that was applied to the following genetic disease tests for dates of service on January 01, 2006 through March 03, 2006 is being reversed. HCPCS Code Description Z2500 Newborn screening panel for phenylketonuria (PKU), galactosemia, primary...
In accordance with the 2006 updates to the Current Procedural Terminology – 4th Edition (CPT-4 code book), the provider manual has been updated to reflect changes in reporting for codes used to bill for Pap smear tests. This section contains information to assist providers in billing for pathology procedures related to cytopathology services. Pap Smear Tests Taking a Papanicolaou...
Effective for dates of service on or after January 01, 2007, the California Department of Health Services (CDHS) is updating the maximum reimbursement amounts for laboratory chemistry procedures. These rates are as follows: Description Rate 1 - 2 clinical chemistry tests $5.82 3 clinical chemistry tests $7....
Effective for dates of service on or after May 1, 2007, CPT-4 code 88150 (cytopathology, slides, cervical or vaginal; manual screening under physician supervision) will be replaced with code 88164 (cytopathology, slides, cervical or vaginal [the Bethesda System]; manual screening under physician supervision) for the Presumptive Eligibility (PE) program. The Bethesda System is the current...
The following CPT-4 codes must be billed with the appropriate split-bill modifiers (26, 99, TC or ZS): 82107, 83698, 83913, 86788, 86789, 87305, 87498, 87640, 87641, 87653 and 87808. Code 88314 is not reimbursable with codes 17311 Ð 17315 for a routine frozen section stain. However, it is separately reimbursable for a non-routine frozen section stain when it is billed with modifier 59. Codes...
From April 23, 2007 to June 24, 2007, Medi-Cal will accept both the HCFA 1500 and CMS-1500 form. Providers using the HCFA 1500, however, can only enter their Medi-Cal provider number. Providers may choose to fully transition to the new CMS-1500 claim form at any time during this two-month period before the use of the CMS-1500 becomes mandatory. Beginning June 25, 2007, Medi-Cal will only accept...