Medi-Cal – Resubmission of EWC Claims for Select Procedure Code

The Department of Health Care Services (DHCS) implemented a policy to include new benefits into the Every Woman Counts (EWC) program to align with the National Breast and Cervical Cancer Early Detection Program. Also, it corrected covered International Classification of Disease, Tenth Revision (ICD-10) code Z11.51 billed with CPT code 87624. This caused claims to erroneously deny with one of the following Remittance Advice Details (RAD) codes:

• 0033: The recipient is not eligible for special program billed and/or restricted services billed.
• 0063: The procedure is not consistent with the recipient’s age.
• 0169: This service is not payable when billed with this diagnosis.

Source: https://mcweb.apps.prd.cammis.medi-cal.ca.gov/assets/AA4C1D42-225C-4571-9B03-0600D0A6AD14/32896_p44749.pdf?access_token=6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO