Presumptive Eligibility Program: Benefits Expanded

Effective 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.

SOURCE: Source
INDUSTRY NEWS TAGS: California Medi-Cal

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