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ICD Code Qualifier Added to CMC Billing and Technical Manual

September 19, 2014

The Pharmacy Billing – Request (Section 1.2.5) section of the 5010 Computer Media Claims (CMC) Billing and Technical Manual is updated to include a Ø2 diagnosis code qualifier for use with ICD-10-CM codes. Claims with a diagnosis code in Field 424-DO must include a diagnosis code qualifier in Field 492-WE. Claim submission of ICD-10 codes is delayed until October 1, 2015.

Since ICD-9 codes remain in effect through September 30, 2015, providers should continue to use Ø1 diagnosis code qualifier in Field 492-WE when a diagnosis code is used in Field 424-DO.

The latest version of the manual is available on the Medi-Cal Computer Media Claims (CMC) Billing and Technical Manual page of the Medi-Cal website.