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

Part 2 – Obstetrics (OB)

111,557 Bytes206,848 Bytes

Medi-Cal Program (00medi-cal)

3,922 Bytes22,016 Bytes

Medi-Cal Provider Manual Contents

9,015 Bytes30,208 Bytes

Manual Organization (0Amanorg)

23,816 Bytes86,016 Bytes

How to Use This Manual (0Bhwtouse)

22,202 Bytes84,992 Bytes

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

18,697 Bytes68,608 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Obstetrics (OB) (2toc ob)

21,835 Bytes76,288 Bytes

Abortions (abort)

15,815 Bytes53,248 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)

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)

73,728 Bytes343,552 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)

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)

21,949 Bytes96,256 Bytes

Diabetes Prevention Program (diabetes)

22,022 Bytes80,384 Bytes

Drug Use Review (DUR) Program (drug)

63,223 Bytes663,040 Bytes

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

16,587 Bytes60,416 Bytes

EPSDT (epsdt)

42,654 Bytes161,792 Bytes

EPSDT/CHDP (epsdt chdp)

23,803 Bytes88,576 Bytes

EPSDT/CHDP: Gateway (epsdt chdp gate)

49,384 Bytes198,656 Bytes

Evaluation & Management (E&M) (eval)

768,349 Bytes1,034,752 Bytes

Every Woman Counts (ev woman)

413,173 Bytes480,768 Bytes

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

45,845 Bytes211,456 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)

21,466 Bytes96,256 Bytes

Hysterectomy (hyst)

38,129 Bytes143,360 Bytes

Immunizations (immun)

12,096 Bytes42,496 Bytes

Immunizations Code List (immun cd)

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)

73,886 Bytes290,816 Bytes

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

71,189 Bytes289,792 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)

15,577 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)

13,511 Bytes57,344 Bytes

Minor Consent Program (minor)

11,687 Bytes41,984 Bytes

Modifiers (modif)

43,074 Bytes275,456 Bytes

Modifiers: Approved List (modif app)

32,124 Bytes158,208 Bytes

Modifiers Used With Procedure Codes (modif used)

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)

15,299 Bytes56,320 Bytes

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

28,207 Bytes115,200 Bytes

Optional Benefits Exclusion (opt ben exc)

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)

34,821 Bytes126,976 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)

19,235 Bytes74,240 Bytes

Pathology: Drug Testing (path drug)

13,239 Bytes49,152 Bytes

Pathology: Immunology (path immun)

26,257 Bytes109,056 Bytes

Pathology: Microbiology (path micro)

90,979 Bytes576,000 Bytes

Pathology: Molecular Pathology (path molec)

18,589 Bytes74,240 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)

22,163 Bytes80,384 Bytes

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

797,252 Bytes915,968 Bytes

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

10,745 Bytes38,912 Bytes

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

12,445 Bytes37,376 Bytes

Pregnancy Determination (preg determ)

34,847 Bytes135,680 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)

12,935 Bytes45,568 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)

9,592 Bytes35,328 Bytes

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

15,739 Bytes55,296 Bytes

Pregnancy: Postpartum and Newborn Referral Services (preg post)

7,356 Bytes45,056 Bytes

Pregnancy: Share of Cost (preg share)

21,788 Bytes74,752 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)

12,367 Bytes44,032 Bytes

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

21,930 Bytes81,920 Bytes

Radiology (radi)

887,317 Bytes997,888 Bytes

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

50,644 Bytes206,336 Bytes

Radiology: Diagnostic (radi dia)

15,388 Bytes55,808 Bytes

Radiology: Diagnostic Ultrasound (radi dia ult)

20,964 Bytes83,456 Bytes

Radiology: Nuclear Medicine (radi nuc)

27,068 Bytes95,744 Bytes

Radiology: Oncology (radi onc)

20,469 Bytes77,824 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)

626,283 Bytes734,208 Bytes

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

12,148 Bytes44,544 Bytes

Sign Language Interpretation (sign)

1,716,671 Bytes1,878,528 Bytes

Sterilization (ster)

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)

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)

11,878 Bytes43,008 Bytes

Surgery: Female Genital System (surg female)

8,553 Bytes32,768 Bytes

Surgery: Laparoscopy and Hysteroscopy (surg lap)

9,960 Bytes36,352 Bytes

Surgery: Male Genital System (surg male)

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)

77,638 Bytes139,776 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)

10,932 Bytes35,328 Bytes

Tuberculosis Program (tuber)

34,221 Bytes142,336 Bytes

Vaccines For Children (VFC) Program (vaccine)



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