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Code Conversion Technical Publications and Support Clarification

October 25, 2017

Information published in the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual and September Medi-Cal Update state that there will be no change to 837i claim transactions. Although the existing computer medium for 837i claim transactions is not changing, the addition of CPT-4 Level I or HCPCS Level II codes which identify the actual services provided should be included on the informational lines for dates of service on or after October 1, 2017.

An informational line details the specific services provided during the global visit and should be listed immediately following the HIPAA-compliant billing code set used to bill the face-to-face encounter with the recipient. Informational lines are not separately reimbursed. When submitting CMC data for informational lines providers should remember:

  • The Revenue Code field (Box 42) on the information claim detail line must always be blank (spaces) or zeros. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV201.
  • The Service Units field (Box 46) on the information claim detail line must always be zeros. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV205.
  • The Total Charges field (Box 47) for each information claim detail line must always be blanks (spaces) or zeros. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV203.
  • Computer Media Claims (CMC) submitted with an informational line on the first detail line of the claim will be rejected. CMC claim detail line 01 must include only HIPAA-compliant billing code sets.
  • When billing an electronic (CMC) claim, if the addition of informational lines causes the claim to exceed 22 lines, the claim must be split and services billed on separate claims. Electronic claims that exceed 22 claim lines with informational lines will be denied in their entirety.