Adjustment to Medicare and Pharmacy Claims Due to Retroactive Rates Update

The Department of Health Care Services (DHCS) updated provider reimbursement

rates for designated physician-administered drug CPT® and HCPCS codes for second

quarter 2022, effective retroactively for dates of service on or after April 1, 2022. If the

rate was increased, the adjustment is positive. If the rate was reduced, the adjustment

is negative.

No action is required on your part. The California Medicaid Management Information

System (MMIS) Fiscal Intermediary will adjust the affected claims. These adjustments

will appear on Remittance Advice Details (RAD) forms beginning June 8, 2023, (for

positive adjustments) and July 13,2023, (for negative adjustments), with RAD code

0893: Retroactive rate adjustments.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2023/32277_p44363.pdf