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

Part 2 – Clinics and Hospitals (CAH)

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)

21,335 Bytes78,848 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Outpatient Services for Clinics and Hospitals (2toc cah)

21,835 Bytes76,288 Bytes

Abortions (abort)

18,854 Bytes62,976 Bytes

Allergy Testing and Desensitization (allergy)

15,815 Bytes53,248 Bytes

Alternative Birthing Centers (altern)

43,432 Bytes160,768 Bytes

Anesthesia (anest)

191,941 Bytes270,848 Bytes

Anesthesia Billing Examples: UB-04 (anest ub)

112,485 Bytes166,400 Bytes

Appeal Form Completion (appeal form)

25,354 Bytes91,136 Bytes

Blood and Blood Derivatives (blood)

101,485 Bytes157,696 Bytes

Blood and Blood Derivatives Billing Examples: UB-04 (blood ub)

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)

10,469 Bytes41,472 Bytes

CCS Program Billing Guidelines (cal child bil guide)

48,780 Bytes77,824 Bytes

California Children's Services (CCS) Program Billing Example: UB-04 Claim Form (cal child bil ub)

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)

35,259 Bytes133,632 Bytes

Cardiology (cardio)

84,722 Bytes121,856 Bytes

Cardiology Billing Example: UB-04 (cardio bil ub)

20,421 Bytes80,896 Bytes

Chemotherapy: An Overview (chemo an over)

51,702 Bytes230,400 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)

116,392 Bytes173,568 Bytes

CIF Special Billing Instructions for Outpatient Services (cif sp op)

64,864 Bytes100,864 Bytes

CIF Submission and Timeliness Instructions (cif sub)

85,169 Bytes156,160 Bytes

Contracted and Non-Contracted Inpatient Services (cont ip)

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)

7,590 Bytes26,112 Bytes

Denti-Cal Program (denti)

10,540 Bytes36,864 Bytes

Denti-Cal Program for Inpatient and Outpatient Services (denti io)

21,949 Bytes96,256 Bytes

Diabetes Prevention Program (diabetes)

21,325 Bytes84,992 Bytes

Dialysis: Chronic Dialysis Services (dial chr)

14,259 Bytes52,736 Bytes

Dialysis: End Stage Renal Disease Services (dial end)

46,639 Bytes78,848 Bytes

Dialysis Examples: UB-04 (dial ex ub)

3,727 Bytes27,136 Bytes

Distinct-Part Long Term Care Facilities (distinct)

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)

18,398 Bytes70,656 Bytes

Durable Medical Equipment (DME): Speech Generating Devices (SGD) (dura spe)

31,279 Bytes134,144 Bytes

End of Life Option Act Services (eloa)

362,891 Bytes528,896 Bytes

End of Life Option Act Services Billing Examples: UB-04 (eloa ub)

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)

18,506 Bytes74,240 Bytes

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

49,384 Bytes198,656 Bytes

Evaluation & Management (E&M) (eval)

768,349 Bytes1,034,752 Bytes

Every Woman Counts (ev woman)

57,044 Bytes94,720 Bytes

Every Woman Counts Billing Examples: UB-04 (ev woman exub)

45,845 Bytes211,456 Bytes

Family Planning (fam planning)

183,060 Bytes249,856 Bytes

Family Planning Billing Example: UB-04 (fam planning ub)

13,843 Bytes43,520 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,676 Bytes32,256 Bytes

Forms Reorder Request: Guidelines (forms reo)

168,257 Bytes333,312 Bytes

Forms Reorder Request: Inpatient and Outpatient Services (forms reo io)

18,779 Bytes63,488 Bytes

Genetic Counseling and Screening (gene coun)

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)

10,481 Bytes40,448 Bytes

Heroin Detoxification Billing Codes (heroin cd)

4,378 Bytes30,720 Bytes

Hoptel Services (hoptel)

23,217 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)

31,746 Bytes119,296 Bytes

Incontinence Medical Supplies (incont)

25,503 Bytes105,472 Bytes

Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics (ind health)

22,045 Bytes105,984 Bytes

Indian Health Services (IHS), Memorandum of Agreement (MOA) 638, Clinics: Billing Codes (ind health cd)

22,364 Bytes94,720 Bytes

Injections: An Overview (inject an over)

57,580 Bytes93,696 Bytes

Injections: Billing Example for UB-04 (inject bil ub)

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)

42,005 Bytes170,496 Bytes

Medicare/Medi-Cal Crossover Claims: Outpatient Services (medi cr op)

818,651 Bytes967,168 Bytes

Medicare/Medi-Cal Crossover Claims: Outpatient Services Billing Examples (medi cr op ex)

36,196 Bytes194,048 Bytes

Medicare/Medi-Cal Crossover Claims: Outpatient Services Medi-Cal Pricing Examples (medi cr op pr)

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)

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)

43,074 Bytes275,456 Bytes

Modifiers: Approved List (modif app)

32,124 Bytes158,208 Bytes

Modifiers Used With Procedure Codes (modif used)

13,882 Bytes47,616 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)

48,639 Bytes80,896 Bytes

Non-Physician Medical Practitioners (NMP) Billing Example: UB-04 (non ph ub)

15,299 Bytes56,320 Bytes

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

44,531 Bytes172,544 Bytes

Ophthalmology (ophthal)

18,667 Bytes79,360 Bytes

Ophthalmology: Diagnosis Codes (ophthal cd)

28,207 Bytes115,200 Bytes

Optional Benefits Exclusion (opt ben exc)

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)

34,821 Bytes126,976 Bytes

Pathology: Billing and Modifiers (path bil)

105,252 Bytes155,648 Bytes

Pathology Billing Examples: UB-04 (path bil ub)

11,916 Bytes44,032 Bytes

Pathology: Blood Collection and Handling (path blood)

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)

18,357 Bytes58,880 Bytes

Physician-Administered Drugs – NDC: UB-04 Billing Instructions (physician ndc ub)

12,637 Bytes46,592 Bytes

Podiatry Services (podi)

61,406 Bytes97,792 Bytes

Podiatry Services Billing Example: UB-04 (podi ub)

22,163 Bytes80,384 Bytes

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

508,026 Bytes609,792 Bytes

Pregnancy: Comprehensive Perinatal Services Program (CPSP) Billing Examples – UB-04 (preg com exu)

10,745 Bytes38,912 Bytes

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

11,019 Bytes39,936 Bytes

Pregnancy: Comprehensive Perinatal Services Program (CPSP) – Los Angeles County Waiver Facilities (preg com los)

12,445 Bytes37,376 Bytes

Pregnancy Determination (preg determ)

34,847 Bytes135,680 Bytes

Pregnancy: Early Care and Diagnostic Services (preg early)

331,004 Bytes432,128 Bytes

Pregnancy Examples: UB-04 (preg ex ub)

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)

14,611 Bytes49,664 Bytes

Prescription Referrals (prescript)

9,081 Bytes32,768 Bytes

Prescription Referrals: Vision Care (prescript vc)

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)

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)

159,249 Bytes217,600 Bytes

Radiology Billing Example: UB-04 (radi bil ub)

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)

8,650 Bytes48,128 Bytes

Rates: Maximum Reimbursement for Outpatient Room Rates (rates max op)

12,139 Bytes40,448 Bytes

Remittance Advice Details (RAD) (remit adv)

29,510 Bytes182,784 Bytes

Remittance Advice Details (RAD) Examples: Outpatient Services (remit ex op)

10,686 Bytes35,328 Bytes

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

30,206 Bytes117,760 Bytes

Respiratory Care (respir)

27,200 Bytes112,128 Bytes

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) (rural)

24,490 Bytes111,616 Bytes

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): Billing Codes (rural cd)

47,373 Bytes80,896 Bytes

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Billing Examples (rural ex)

109,943 Bytes166,400 Bytes

Share of Cost (SOC): UB-04 for Outpatient Services (share op)

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)

52,020 Bytes84,480 Bytes

Supplies and Drugs Billing Examples: UB-04 (supp drug bil)

11,685 Bytes45,056 Bytes

Supplies and Drugs for Outpatient Services (supp drug op)

19,634 Bytes70,656 Bytes

Surgery (surg)

15,314 Bytes53,248 Bytes

Surgery: Auditory System (surg aud)

244,720 Bytes334,848 Bytes

Surgery Billing Examples: UB-04 (surg bill ub)

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)

15,747 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)

3,951 Bytes28,160 Bytes

Surgery: Room Reimbursement (surg room)

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)

25,151 Bytes101,376 Bytes

Transplants (transplant)

10,932 Bytes35,328 Bytes

Tuberculosis Program (tuber)

370,701 Bytes564,224 Bytes

UB-04 Completion: Outpatient Services (ub comp op)

25,427 Bytes61,952 Bytes

UB-04 Special Billing Instructions for Outpatient Services (ub spec op)

21,512 Bytes88,576 Bytes

UB-04 Submission and Timeliness Instructions (ub sub)

15,521 Bytes58,880 Bytes

UB-04 Tips for Billing: Outpatient Services (ub tips op)

34,221 Bytes142,336 Bytes

Vaccines For Children (VFC) Program (vaccine)



Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.