Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Part 2 – General Medicine (GM)

111,557 Bytes206,848 Bytes

Medi-Cal Program (00medi-cal)

7,576 Bytes31,232 Bytes

Medi-Cal Provider Manual Contents

9,428 Bytes35,328 Bytes

Manual Organization (0Amanorg)

24,093 Bytes86,528 Bytes

How to Use This Manual (0Bhwtouse)

22,202 Bytes84,992 Bytes

Getting Started: Where to Find the Answers (0C get start)

20,635 Bytes76,800 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): General Medicine (2toc gm)

22,132 Bytes77,312 Bytes

Abortions (abort)

18,854 Bytes62,976 Bytes

Allergy Testing and Desensitization (allergy)

15,928 Bytes52,736 Bytes

Alternative Birthing Centers (altern)

43,432 Bytes160,768 Bytes

Anesthesia (anest)

725,753 Bytes844,288 Bytes

Anesthesia Billing Examples: CMS-1500 (anest cms)

112,485 Bytes166,400 Bytes

Appeal Form Completion (appeal form)

26,785 Bytes95,232 Bytes

Blood and Blood Derivatives (blood)

881,838 Bytes1,001,984 Bytes

Blood and Blood Derivatives Billing Examples: CMS-1500 (blood cms)

14,984 Bytes52,736 Bytes

California Children's Services (CCS) Program (cal child)

5,600 Bytes32,768 Bytes

California Children’s Services (CCS) Program Approved Hospitals (cal child appr)

9,823 Bytes32,256 Bytes

California Children's Services (CCS) Program Billing (cal child bil)

460,330 Bytes527,360 Bytes

California Children's Services (CCS) Program Billing Example: CMS-1500 (cal child bil cms)

10,469 Bytes41,472 Bytes

CCS Program Billing Guidelines (cal child bil guide)

20,850 Bytes112,128 Bytes

California Children’s Services (CCS) Program County Office Directory (cal child county)

16,877 Bytes55,808 Bytes

California Children's Services (CCS) Program Eligibility (cal child elig)

9,495 Bytes34,304 Bytes

California Children's Services (CCS) Program Medical Therapy Program (cal child med)

21,122 Bytes77,824 Bytes

California Children's Services (CCS) Program Provider Paneling (cal child panel)

16,759 Bytes90,624 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Physicians and Podiatrists (DHS 4514)

20,274 Bytes102,912 Bytes

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Allied Health Care Professionals (DHS 4515 )

12,914 Bytes72,704 Bytes

California Children's Services (CCS) Program Referrals (cal child ref)

29,815 Bytes105,984 Bytes

California Children's Services (CCS) Program Service Authorization Request (SAR) (cal child sar)

80,060 Bytes357,376 Bytes

California Children’s Services (CCS) Program Service Code Groupings (cal child ser)

4,199 Bytes26,624 Bytes

California Children’s Services (CCS) Program Special Care Centers (cal child spec)

35,259 Bytes133,632 Bytes

Cardiology (cardio)

819,250 Bytes929,792 Bytes

Cardiology Billing Example: CMS-1500 (cardio bil cms)

20,421 Bytes80,896 Bytes

Chemotherapy: An Overview (chemo an over)

52,383 Bytes232,960 Bytes

Chemotherapy: Drugs A-D Policy (chemo drug a-d)

46,230 Bytes191,488 Bytes

Chemotherapy: Drugs E-O Policy (chemo drug e-o)

46,982 Bytes188,416 Bytes

Chemotherapy: Drugs P-Z Policy (chemo drug p-z)

126,123 Bytes209,920 Bytes

CIF Completion (cif co)

103,149 Bytes162,304 Bytes

CIF Special Billing Instructions (cif sp)

64,864 Bytes100,864 Bytes

CIF Submission and Timeliness Instructions (cif sub)

564,132 Bytes716,800 Bytes

CMS-1500 Completion (cms comp)

194,573 Bytes257,024 Bytes

CMS-1500 Special Billing Instructions (cms spec)

17,983 Bytes77,824 Bytes

CMS-1500 Submission and Timeliness Instructions (cms sub)

13,571 Bytes51,712 Bytes

CMS-1500 Tips for Billing (cms tips)

75,258 Bytes121,344 Bytes

Contracted Inpatient Services for Medical Services (cont ms)

17,884 Bytes70,656 Bytes

Correct Coding Initiative: National (correct)

133,630 Bytes174,592 Bytes

Correct Coding Initiative: National – Claim Preparation (correct cod)

7,749 Bytes30,720 Bytes

Dental Benefits (dental)

8,034 Bytes30,720 Bytes

Denti-Cal Program (denti)

21,949 Bytes96,256 Bytes

Diabetes Prevention Program (diabetes)

14,259 Bytes52,736 Bytes

Dialysis: End Stage Renal Disease Services (dial end)

445,543 Bytes510,464 Bytes

Dialysis Example: CMS-1500 (dial ex cms)

22,022 Bytes80,384 Bytes

Drug Use Review (DUR) Program (drug)

67,997 Bytes672,256 Bytes

Drugs: Contract Drugs List Part 5 – Authorized Manufacturer Labeler Codes (drugs cdl p5)

11,375 Bytes44,032 Bytes

Drugs: Contract Drugs List Part 8 – Step Therapy (drugs cdl p8)

31,279 Bytes134,144 Bytes

End of Life Option Act Services (eloa)

981,997 Bytes1,128,448 Bytes

End of Life Option Act Services Billing Examples: CMS-1500 (eloa cms)

16,587 Bytes60,416 Bytes

EPSDT (epsdt)

43,482 Bytes163,840 Bytes

EPSDT/CHDP (epsdt chdp)

24,087 Bytes89,088 Bytes

EPSDT/CHDP: Gateway (epsdt chdp gate)

18,506 Bytes74,240 Bytes

EPSDT/CHDP: School-Based Services (epsdt chdp school)

49,384 Bytes198,656 Bytes

Evaluation & Management (E&M) (eval)

450,367 Bytes705,024 Bytes

Every Woman Counts (ev woman)

413,173 Bytes480,768 Bytes

Every Woman Counts Billing Examples: CMS-1500 (ev woman exc)

46,202 Bytes212,480 Bytes

Family Planning (fam planning)

446,076 Bytes517,120 Bytes

Family Planning Billing Example: CMS-1500 (fam planning cms)

13,843 Bytes43,520 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,676 Bytes32,256 Bytes

Forms Reorder Request: Guidelines (forms reo)

146,795 Bytes278,528 Bytes

Forms Reorder Request: Medical Services and Allied Health (forms reo ma)

18,779 Bytes63,488 Bytes

Genetic Counseling and Screening (gene coun)

450,589 Bytes516,608 Bytes

Genetic Disease Screening Billing Examples: CMS-1500 (gene ex)

32,701 Bytes118,272 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

11,392 Bytes40,960 Bytes

HCPCS Introduction (hcpcs)

10,880 Bytes54,272 Bytes

HCPCS Level III Interim Code List: Reimbursable Medi-Cal-Only Codes (hcpcs iii)

8,856 Bytes31,744 Bytes

Heroin Detoxification (heroin)

23,163 Bytes82,432 Bytes

Hospice Care (hospic)

21,466 Bytes96,256 Bytes

Hysterectomy (hyst)

38,129 Bytes143,360 Bytes

Immunizations (immun)

12,096 Bytes42,496 Bytes

Immunizations Code List (immun cd)

31,167 Bytes117,760 Bytes

Incontinence Medical Supplies (incont)

22,364 Bytes94,720 Bytes

Injections: An Overview (inject an over)

461,023 Bytes528,384 Bytes

Injections: Billing Example for CMS-1500 (inject bil cms)

40,909 Bytes147,968 Bytes

Injections: Code List (inject cd list)

72,740 Bytes283,136 Bytes

Injections: Drugs A-D Policy (inject drug a-d)

65,254 Bytes257,536 Bytes

Injections: Drugs E-H Policy (inject drug e-h)

47,987 Bytes188,416 Bytes

Injections: Drugs I-M Policy (inject drug i-m)

53,048 Bytes204,288 Bytes

Injections: Drugs N-R Policy (inject drug n-r)

43,007 Bytes163,328 Bytes

Injections: Drugs S-Z Policy (inject drug s-z)

10,478 Bytes38,912 Bytes

Injections: Hydration (inject hydra)

31,612 Bytes119,296 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 (medi cr cms)

1,427,608 Bytes1,592,320 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 Billing Examples for Medical Services (medi cr cms exm)

33,466 Bytes194,560 Bytes

Medicare/Medi-Cal Crossover Claims: CMS-1500 Pricing Examples for Medical Services (medi cr cms prm)

8,336 Bytes31,744 Bytes

Medicare Non-Covered Services: Charts Introduction (medi non cha)

11,651 Bytes49,152 Bytes

Medicare Non-Covered Services: CPT® Codes (medi non cpt)

15,628 Bytes63,488 Bytes

Medicare Non-Covered Services: HCPCS Codes (medi non hcp)

4,205 Bytes28,672 Bytes

Medicare Procedures: Medi-Cal Code Correlation List (medi pro med)

33,369 Bytes121,344 Bytes

Medicine (medne)

19,932 Bytes72,704 Bytes

Medicine: Neurology and Neuromuscular (medne neu)

13,811 Bytes50,176 Bytes

Medicine: Non-Invasive Vascular Diagnostic Studies (medne non)

12,702 Bytes45,056 Bytes

Medicine: Otorhinolaryngologic Services (medne oto)

14,927 Bytes53,760 Bytes

Medicine: Pulmonary (medne pul)

21,603 Bytes80,384 Bytes

Medicine: Telehealth (medne tele)

13,511 Bytes57,344 Bytes

Minor Consent Program (minor)

11,687 Bytes41,984 Bytes

Modifiers (modif)

42,825 Bytes275,456 Bytes

Modifiers: Approved List (modif app)

32,124 Bytes158,208 Bytes

Modifiers Used With Procedure Codes (modif used)

13,994 Bytes52,224 Bytes

Newborn Hearing Screening Program (newborn)

28,271 Bytes104,448 Bytes

Non-Injectable Drugs (non inject)

64,073 Bytes383,488 Bytes

Non-Physician Medical Practitioners (NMP) (non ph)

445,113 Bytes509,952 Bytes

Non-Physician Medical Practitioners (NMP) Billing Example: CMS-1500 (non ph cms)

15,697 Bytes57,856 Bytes

Once-in-a-Lifetime Procedure Codes (once)

44,990 Bytes172,544 Bytes

Ophthalmology (ophthal)

18,667 Bytes79,360 Bytes

Ophthalmology: Diagnosis Codes (ophthal cd)

11,262 Bytes40,448 Bytes

Osteopathic Manipulative Treatment (osteo)

16,821 Bytes59,904 Bytes

Other Health Coverage (OHC) (oth hlth)

13,493 Bytes50,176 Bytes

Other Health Coverage (OHC): CPT® and HCPCS Codes (oth hlth cpt)

20,838 Bytes79,360 Bytes

Pathology: An Overview of Enrollment and Proficiency Testing Requirements (path an over)

38,402 Bytes136,704 Bytes

Pathology: Billing and Modifiers (path bil)

97,427 Bytes131,584 Bytes

Pathology Billing Example: CMS-1500 (path bil cms)

11,916 Bytes44,032 Bytes

Pathology: Blood Collection and Handling (path blood)

449,504 Bytes513,024 Bytes

Pathology: Blood Collection and Handling Billing Examples: CMS-1500 (path blood ex)

27,004 Bytes147,968 Bytes

Pathology: Chemistry (path chem)

14,854 Bytes53,760 Bytes

Pathology: Cytopathology (path cyto)

18,851 Bytes73,216 Bytes

Pathology: Drug Testing (path drug)

13,239 Bytes49,152 Bytes

Pathology: Immunology (path immun)

28,806 Bytes117,760 Bytes

Pathology: Microbiology (path micro)

90,979 Bytes576,000 Bytes

Pathology: Molecular Pathology (path molec)

18,520 Bytes73,728 Bytes

Pathology: Organ or Disease-Oriented Panels (path organ)

14,434 Bytes51,712 Bytes

Pathology: Surgical (path surg)

10,340 Bytes37,888 Bytes

Pathology: Urinalysis (path urin)

15,656 Bytes54,272 Bytes

Physician-Administered Drugs: NDC (physician ndc)

93,506 Bytes131,584 Bytes

Physician-Administered Drugs – NDC: CMS-1500 Billing Instructions (physician ndc cms)

12,637 Bytes46,592 Bytes

Podiatry Services (podi)

451,483 Bytes517,120 Bytes

Podiatry Services Billing Examples: CMS-1500 (podi cms)

22,163 Bytes80,384 Bytes

Pregnancy: Comprehensive Perinatal Services Program (CPSP) (preg com)

798,140 Bytes919,552 Bytes

Pregnancy: Comprehensive Perinatal Services Program (CPSP) Billing Examples - CMS-1500 (preg com exc)

11,303 Bytes44,544 Bytes

Pregnancy: Comprehensive Perinatal Services Program (CPSP) List of Billing Codes (preg com lis)

12,445 Bytes37,376 Bytes

Pregnancy Determination (preg determ)

37,385 Bytes142,336 Bytes

Pregnancy: Early Care and Diagnostic Services (preg early)

2,042,696 Bytes2,301,440 Bytes

Pregnancy Examples: CMS-1500 (preg ex cms)

12,126 Bytes43,520 Bytes

Pregnancy: Fetal Monitoring, Labor and Delivery Services (preg fetal)

13,133 Bytes46,592 Bytes

Pregnancy: Global Billing (preg glo)

12,173 Bytes37,376 Bytes

Pregnancy: Global Billing Codes (preg glo cd)

10,753 Bytes38,400 Bytes

Pregnancy: Per-Visit Billing (preg per)

9,705 Bytes35,840 Bytes

Pregnancy: Per-Visit Billing Codes (preg per cd)

15,739 Bytes55,296 Bytes

Pregnancy: Postpartum and Newborn Referral Services (preg post)

8,048 Bytes32,256 Bytes

Pregnancy: Share of Cost (preg share)

14,611 Bytes49,664 Bytes

Prescription Referrals (prescript)

9,081 Bytes32,768 Bytes

Prescription Referrals: Vision Care (prescript vc)

22,197 Bytes76,288 Bytes

Presumptive Eligibility for Pregnant Women (presum)

29,420 Bytes104,448 Bytes

Presumptive Eligibility for Pregnant Women: Billing Codes (presum bill)

29,420 Bytes30,720 Bytes

Form: Presumptive Eligibility for Pregnant Women Provider Fact Sheet (presumb prv fact)

10,177 Bytes33,280 Bytes

Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet (presumfpatfact)

17,006 Bytes77,824 Bytes

Presumptive Eligibility for Pregnant Women Program Patient Fact Sheet (MC 264) (Spanish)

17,006 Bytes27,648 Bytes

Form: Explanation of Ineligibility For The Presumptive Eligibility For Pregnant Women Program (presumjnobene)

21,167 Bytes82,432 Bytes

Presumptive Eligibility for Pregnant Women Program Process (presum proc)

17,978 Bytes63,488 Bytes

Presumptive Eligibility for Pregnant Women Provider Enrollment Instructions (presum prov)

10,006 Bytes36,352 Bytes

Presumptive Eligibility for Pregnant Women Provider Enrollment Checklist (presum prov enroll frm)

30,030 Bytes158,720 Bytes

Preventive Services (prev)

12,367 Bytes44,032 Bytes

Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry) (prov bil)

20,597 Bytes75,264 Bytes

Psychiatry (psych)

21,930 Bytes81,920 Bytes

Radiology (radi)

887,317 Bytes997,888 Bytes

Radiology Billing Example: CMS-1500 (radi bil cms)

50,747 Bytes206,848 Bytes

Radiology: Diagnostic (radi dia)

15,388 Bytes55,808 Bytes

Radiology: Diagnostic Ultrasound (radi dia ult)

21,069 Bytes83,968 Bytes

Radiology: Nuclear Medicine (radi nuc)

27,068 Bytes95,744 Bytes

Radiology: Oncology (radi onc)

20,671 Bytes78,336 Bytes

Rates: Maximum Reimbursement (rates max)

9,028 Bytes34,304 Bytes

Rates: Maximum Reimbursement for Laboratories (rates max lab)

12,139 Bytes40,448 Bytes

Remittance Advice Details (RAD) (remit adv)

26,600 Bytes166,912 Bytes

Remittance Advice Details (RAD) Examples: Allied Health and Medical Services (remit ex am)

10,686 Bytes35,328 Bytes

Remittance Advice Details (RAD): Payments and Claim Status (remit pay)

30,206 Bytes117,760 Bytes

Respiratory Care (respir)

626,283 Bytes734,208 Bytes

Share of Cost (SOC): CMS-1500 (share cms)

12,148 Bytes44,544 Bytes

Sign Language Interpretation (sign)

18,063 Bytes72,192 Bytes

Specialty Mental Health Services (spec)

19,640 Bytes109,568 Bytes

Specialty Mental Health Services: Eligible Counties (spec cnty)

1,716,671 Bytes1,878,528 Bytes

Sterilization (ster)

12,551 Bytes46,592 Bytes

Subacute Care Programs: Adult (subacut adu)

12,807 Bytes56,832 Bytes

Subacute Care Programs: Billing Codes (subacut code)

13,657 Bytes51,200 Bytes

Subacute Care Programs: Level of Care for Adults and Children (subacut lev)

14,250 Bytes59,392 Bytes

Form: Information for Authorization/Reauthorization of Subacute Care Services – Adult Subacute Program (DHS 6200 A)

17,691 Bytes70,144 Bytes

Subacute Care Programs: Pediatric (subacut ped)

11,149 Bytes39,424 Bytes

Supplies and Drugs (supp drug)

8,898 Bytes34,304 Bytes

Supplies and Drugs for Medical Services (supp drug ms)

19,634 Bytes70,656 Bytes

Surgery (surg)

15,154 Bytes52,224 Bytes

Surgery: Auditory System (surg aud)

885,256 Bytes1,024,512 Bytes

Surgery Billing Examples: CMS-1500 (surg bil cms)

25,735 Bytes101,376 Bytes

Surgery: Billing With Modifiers (surg bil mod)

27,663 Bytes101,376 Bytes

Surgery: Cardiovascular System (surg cardio)

17,375 Bytes61,440 Bytes

Surgery: Digestive System (surg digest)

34,192 Bytes142,848 Bytes

Surgery: Eye and Ocular Adnexa (surg eye)

11,878 Bytes43,008 Bytes

Surgery: Female Genital System (surg female)

15,936 Bytes57,344 Bytes

Surgery: Integumentary System (surg integ)

8,553 Bytes32,768 Bytes

Surgery: Laparoscopy and Hysteroscopy (surg lap)

9,960 Bytes36,352 Bytes

Surgery: Male Genital System (surg male)

22,637 Bytes83,456 Bytes

Surgery: Musculoskeletal System (surg muscu)

28,356 Bytes105,984 Bytes

Surgery: Nervous System (surg nerv)

18,211 Bytes64,000 Bytes

Surgery: Urinary System (surg urin)

8,922 Bytes32,768 Bytes

TAR and Non-Benefit: Introduction to List (tar and non)

22,986 Bytes99,328 Bytes

TAR and Non-Benefit List: Codes 10000 – 19999 (tar and non cd1)

27,967 Bytes120,320 Bytes

TAR and Non-Benefit List: Codes 20000 – 29999 (tar and non cd2)

32,752 Bytes139,776 Bytes

TAR and Non-Benefit List: Codes 30000 – 39999 (tar and non cd3)

29,886 Bytes132,608 Bytes

TAR and Non-Benefit List: Codes 40000 – 49999 (tar and non cd4)

25,026 Bytes98,304 Bytes

TAR and Non-Benefit List: Codes 50000 – 59999 (tar and non cd5)

28,003 Bytes115,200 Bytes

TAR and Non-Benefit List: Codes 60000 – 69999 (tar and non cd6)

12,930 Bytes48,128 Bytes

TAR and Non-Benefit List: Codes 70000 – 79999 (tar and non cd7)

19,271 Bytes71,680 Bytes

TAR and Non-Benefit List: Codes 80000 – 89999 (tar and non cd8)

37,798 Bytes149,504 Bytes

TAR and Non-Benefit List: Codes 90000 – 99999 (tar and non cd9)

78,408 Bytes141,824 Bytes

TAR Completion (tar comp)

294,934 Bytes543,232 Bytes

TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer)

29,312 Bytes121,856 Bytes

TAR Field Office Addresses (tar field)

104,194 Bytes151,552 Bytes

TAR Submission: Transmittal Form (tar submis)

10,532 Bytes33,792 Bytes

TAR: Submitting Appeals (tar submit)

10,685 Bytes38,400 Bytes

Transgender Services (transgender)

25,151 Bytes101,376 Bytes

Transplants (transplant)

10,932 Bytes35,328 Bytes

Tuberculosis Program (tuber)

34,221 Bytes142,336 Bytes

Vaccines For Children (VFC) Program (vaccine)



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