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    • April 27, 2017

    Providers submitting electronic Treatment Authorization Requests (eTARs) for procedure codes that do not normally require a TAR must select the special handling description “Cannot bill direct, TAR is required,” which is found in the Patient Information section of the eTAR application. Further information can be found in the TAR Overview section... more


    • January 3, 2007

    Effective for dates of service on or after January 01, 2007, the California Department of Health Services (CDHS) is updating the maximum reimbursement amounts for laboratory chemistry procedures. These rates are as follows: Description Rate 1 - 2 clinical chemistry tests $5.82... more


    • September 1, 2006

    In accordance with the 2006 updates to the Current Procedural Terminology – 4th Edition (CPT-4 code book), the provider manual has been updated to reflect changes in reporting for codes used to bill for Pap smear tests. This section contains information to assist providers in billing for pathology procedures related to cytopathology... more


    • July 2, 2007

    From April 23, 2007 to June 24, 2007, Medi-Cal will accept both the HCFA 1500 and CMS-1500 form. Providers using the HCFA 1500, however, can only enter their Medi-Cal provider number. Providers may choose to fully transition to the new CMS-1500 claim form at any time during this two-month period before the use of the CMS-1500 becomes mandatory.... more


    • August 1, 2006

    Beginning September 2006, Medi–Cal providers will be able to register their National Provider Identifier (NPI) with the California Department of Health Services (CDHS) through an automated collection system. A new NPI Web page will appear on the Medi-Cal Web site that will contain the link to the NPI registration tool. HIPAA mandates the... more


    • June 1, 2005

    Until the statewide issuance of the new 14–character Medi–Cal Benefits Identification Cards (BICs) is completed , Medi–Cal recipients will have a BIC with either a 10– or 14–character ID. The claims processing system will accept both types of BIC ID numbers until new billing requirements are implemented in late 2005 or early 2006... more


    • May 2, 2005

    Medi-Cal has issued a claim submission reminder to providers submitting for Children's Treatment Program (CTP). The claim must include a valid recipient identification number, Benefits Identification Card (BIC) and Client Identification Number or Social Security Number. The PM 160 form must be attached.


    • April 1, 2005

    Sputum Procedure Billing and Rate Update Effective for dates of service on or after April 04, 2005, CPT–4 code 89220 (sputum, obtaining specimen, aerosol induced technique) is no longer billed "By Report," and also is exempt from the Clinical Laboratory Improvement Amendment (CLIA) edits. The Medi–Cal maximum reimbursement rate for this code... more