Medi-Cal Frequency Limits Updated for COVID-19 Related Laboratory Codes

Effective retroactively for dates of service on or after the effective dates of the codes listed below, the frequency limit for select COVID-19 related laboratory codes has been updated. See the table for current frequency limits and the effective date.

Medical justification with a Treatment Authorization Request/Service Authorization Request (TAR/SAR) to override the frequency limit for these laboratory codes may be allowed.

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 appropriation and 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.

Procedure Code	Frequency Limit (per day, any provider)	Effective Date
86328	3	7/1/2020
86408	1	1/1/2021
86409	1	1/1/2021
86413	3	1/1/2021
86769	3	7/1/2020
87426	3	1/1/2021
87428	3	7/1/2021
87635	2	7/1/2020
87636	3	1/1/2021
87637	3	1/1/2021
87811	3	1/1/2021
C9803	2	10/1/2020
G2023	2	7/1/2020
G2024	2	7/1/2020
U0001	2	7/1/2020
U0002	2	7/1/2020
U0003	2	7/1/2020
U0004	2	7/1/2020

 

Source: https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_31132_57.aspx