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- Adjustment to Medicare and Pharmacy Claims Due to Retroactive Rates Update
Adjustment to Medicare and Pharmacy Claims Due to Retroactive Rates Update
July 10, 2023The 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