Clinical Laboratory Rates Triennial Update

Effective retroactively for dates of service on or after July 1, 2020, reimbursement rates for various clinical laboratory services have been updated.

In accordance with Assembly Bill 1494 (Chapter 28, Statutes of 2012) and the Welfare and Institutions Code (W&I Code), section 14105.22(3)(D), the Department of Health Care Services (DHCS) has developed reimbursement rates based on the triennial weighted average third-party payer rate methodology.

The updated rate information for each impacted code is available on the Medi-Cal Rates page.

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because Medi-Cal had not yet implemented the system changes to support appropriate adjudication. Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Source: https://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/gm202105.aspx#a10