Billing Restrictions

In the August 2007 Medi-Cal Update, restrictions for billing CPT-4 codes 83001 (gonadotropin; follicle stimulating hormone [FSH]) and 83002 (Éluteinizing hormone [LH]) were announced, including diagnostic billing code requirements. Effective for dates of service on or after September 1, 2007, additional gender restrictions apply to the diagnostic codes listed below when billed in conjunction with CPT-4 codes 83001 and 83002.

The following ICD-9-CM codes may be used only for female recipients:

• 174.0 – 174.9 627.0 – 627.9
• 220 628.0 – 628.1
• 256.0 752.0 – 752.49
• 626.0 758.6
• 626.9

The following ICD-9-CM codes may be used only for male recipients:

• 072.0 456.4
• 175.0 – 175.9 606 – 606.9
• 185 752.5 – 752.69
• 257.0 752.8 – 752.89
• 259.5 758.7