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Family PACT Claims with Diagnosis Code Z30.9 are Being Erroneously Denied

October 30, 2015

The Department of Health Care Services (DHCS) has identified an issue where Family Planning, Access, Care and Treatment (Family PACT) Program claims are being erroneously denied with the following procedure codes when billed with ICD-10-CM diagnosis code Z30.9 (encounter for contraceptive management, unspecified):

CPT-4 Codes
99201 – 99203
99211 – 99214
99401 – 99403

HCPCS Codes
A4267
A4269
S5199
S9445
S9446

These claims are being denied with Remittance Advice Details (RAD) code 0169: This service is not payable when billed with this diagnosis. DHCS is correcting this issue and will alert providers when the issue is resolved.

Providers should continue to submit claims in a timely manner. Affected claims will be reprocessed via an Erroneous Payment Correction (EPC). Providers are encouraged to check the Medi-Cal website regularly for updates regarding this issue.