Medi-Cal – Adjustment of Claims Due to Radiology Reimbursement Rate Updates

The Department of Health Care Services (DHCS) updated reimbursement rates for Radiology services for select procedure codes, effective retroactively for dates of service on or after January 1, 2021. 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 December 23, 2021 (for positive adjustments), and January 27, 2022 (for negative adjustments), with RAD code 0893: Retroactive rate adjustment.

Source: https://files.medi-cal.ca.gov/pubsdoco/epc/2021/31551_p43237.pdf