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Erroneously Denied Claims for Antenatal Ultrasound

January 19, 2016

The Department of Health Care Services (DHCS) has identified a claims processing issue that may cause claims for antenatal ultrasound to erroneously deny when billed with CPT-4 codes 76801, 76802, 76805, 76810 – 76812 and 76815 – 76817, and ICD-10-CM codes O09.511 – O09.513 or O09.521 – O09.523.

DHCS will notify 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.