Presumptive Eligibility Program: Benefits Expanded
September 1, 2008Effective retroactively for dates of service on or after September 1, 2005, the following obstetric panel procedure codes are Medi-Cal benefits for the Presumptive Eligibility (PE) Program:
| CPT-4 Code | Description |
| 82951, 82952 | Glucose; tolerance test (GTT) |
| 85004, 85007, 85009 85025, 85027 | Blood count |
| 86592 | Syphilis test;qualitative |
| 86762 | Antibody; rubella |
| 86850 | Antibody screen |
| 86900, 86901 | Blood typing |
| 87340 | Infectious agent detection |
| 87621 | Papillomavirus, human |
| 88141, 88174, 88175 | Cytopathology, cervical or vaginal |
| 88300, 88304, 88305 | Surgical pathology |
Claims for services provided to PE recipients for codes 84702 (gondadotropin, chorionic (hCG); quantitative) and 84703 (gondadotropin, chorionic (hCG); qualitative) will no longer be benefits only when an ectopic pregnancy has been established.
The same diagnosis restrictions that apply to Medi-Cal recipients for codes 84702 and 84703 will also apply to PE recipients. (Refer to the Pathology section in the manual.)
Claims for services provided to PE recipients that were previously denied for one of the procedure codes identified above will be automatically reprocessed.