Billing Beat

Medi-Cal: Select Pathology Codes No Longer Split Billable

May 17, 2016

Effective retroactively for dates of service on or after October 1, 2015, select HCPCS and CPT codes are no longer split billable. Claim lines with the following codes must not be billed with modifiers 26, TC or 99, and do not require a modifier:

  • HCPCS codes G0472 and G6040
  • CPT-4 codes 80163, 80165, 80300 – 80304, 80320 – 80377, 81288, 81420, 81435, 81436, 87505 – 87507, 87624, 87625 and 87806

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