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Correction: Code Conversion Technical Publications and Support Clarification

July 26, 2018

In October and November 2017, billing instructions were published regarding informational line billing for FQHC/RHC/IHS-MOA providers. This correction pertains to the information published in the Medi-Cal Computer Media Claim (CMC) Billing and Technical Manual - Special Billing Instructions, HIPAA Code Conversion FAQs, Recorded Webinars and Provider Training on the Medi-Cal Learning Portal (MLP) and Newsflashes.

The allowable characters when completing information lines in the Revenue Code field (Box 42), Service Units field (Box 46), and Total Charges field (Box 47) have changed. 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.

The addition of CPT Category 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. When submitting CMC data for informational lines, providers should remember:

  • The Revenue Code field (Box 42) on the information claim detail line must be a 4-digit revenue code. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV201.
  • The Service Units field (Box 46) on the information claim detail line may 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 be zeros. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV203.
  • Modifiers should accompany procedure codes on informational lines, when applicable.
  • CMCs submitted with an informational line on the first detail line of the claim will be rejected. CMC detail line 01 must include only HIPAA-compliant billing code sets.
  • When billing electronic CMCs, if the addition of informational lines causes the claim to exceed 22 lines, the claim must be split with services billed on separate claims. Electronic claims that exceed 22 claim lines with informational lines will be denied in their entirety.