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)

106,894 Bytes206,336 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)

21,648 Bytes82,944 Bytes

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

20,467 Bytes75,264 Bytes

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

20,594 Bytes72,704 Bytes

Abortions (abort)

17,249 Bytes62,464 Bytes

Allergy Testing and Desensitization (allergy)

14,094 Bytes48,128 Bytes

Alternative Birthing Centers (altern)

41,212 Bytes159,232 Bytes

Anesthesia (anest)

190,291 Bytes268,800 Bytes

Anesthesia Billing Examples: UB-04 (anest ub)

112,485 Bytes166,400 Bytes

Appeal Form Completion (appeal form)

23,747 Bytes87,040 Bytes

Blood and Blood Derivatives (blood)

101,485 Bytes157,696 Bytes

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

15,572 Bytes53,248 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)

9,952 Bytes40,448 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)

36,132 Bytes67,072 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)

28,617 Bytes103,424 Bytes

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

67,694 Bytes300,032 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)

33,252 Bytes126,976 Bytes

Cardiology (cardio)

84,362 Bytes121,856 Bytes

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

19,568 Bytes79,360 Bytes

Chemotherapy: An Overview (chemo an over)

45,869 Bytes202,752 Bytes

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

39,420 Bytes156,672 Bytes

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

41,042 Bytes166,400 Bytes

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

10,361 Bytes37,376 Bytes

Child Health and Disability Prevention (CHDP) Program (child)

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)

17,679 Bytes70,144 Bytes

Correct Coding Initiative: National (correct)

132,668 Bytes173,568 Bytes

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

7,193 Bytes26,112 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)

20,493 Bytes80,896 Bytes

Dialysis: Chronic Dialysis Services (dial chr)

13,782 Bytes47,104 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)

59,523 Bytes627,200 Bytes

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

28,462 Bytes131,584 Bytes

End of Life Option Act Services (eloa)

191,804 Bytes284,160 Bytes

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

47,397 Bytes195,072 Bytes

Evaluation & Management (E&M) (eval)

2,002,427 Bytes2,372,096 Bytes

Every Woman Counts (ev woman)

56,610 Bytes94,208 Bytes

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

45,083 Bytes208,384 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)

18,251 Bytes58,880 Bytes

Genetic Counseling and Screening (gene coun)

30,815 Bytes112,640 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

14,749 Bytes51,200 Bytes

HCPCS Introduction (hcpcs)

11,254 Bytes55,296 Bytes

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

8,856 Bytes31,744 Bytes

Heroin Detoxification (heroin)

8,809 Bytes31,232 Bytes

Heroin Detoxification Billing Codes (heroin cd)

4,378 Bytes30,720 Bytes

Hoptel Services (hoptel)

21,642 Bytes79,360 Bytes

Hospice Care (hospic)

20,787 Bytes94,208 Bytes

Hysterectomy (hyst)

37,724 Bytes143,360 Bytes

Immunizations (immun)

11,650 Bytes37,888 Bytes

Immunizations Code List (immun cd)

30,924 Bytes121,856 Bytes

Incontinence Medical Supplies (incont)

13,992 Bytes87,040 Bytes

Incontinence Supplies Prescription Form: Completion (incont sup com)

7,770 Bytes53,248 Bytes

Form: Incontinence Supplies Prescription Form

18,164 Bytes60,416 Bytes

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

20,096 Bytes100,864 Bytes

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

17,363 Bytes68,608 Bytes

Injections: An Overview (inject an over)

57,239 Bytes92,672 Bytes

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

33,202 Bytes112,640 Bytes

Injections: Code List (inject cd list)

65,131 Bytes245,248 Bytes

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

57,165 Bytes229,888 Bytes

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

41,709 Bytes155,648 Bytes

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

37,206 Bytes136,704 Bytes

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

41,696 Bytes156,160 Bytes

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

10,069 Bytes37,888 Bytes

Injections: Hydration (inject hydra)

41,125 Bytes163,328 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)

7,951 Bytes26,624 Bytes

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

11,004 Bytes48,128 Bytes

Medicare Non-Covered Services: CPT-4 Codes (medi non cpt)

15,653 Bytes65,536 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)

32,944 Bytes119,808 Bytes

Medicine (medne)

18,921 Bytes69,120 Bytes

Medicine: Neurology and Neuromuscular (medne neu)

13,235 Bytes44,544 Bytes

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

12,352 Bytes44,032 Bytes

Medicine: Otorhinolaryngologic Services (medne oto)

14,508 Bytes48,640 Bytes

Medicine: Pulmonary (medne pul)

20,141 Bytes71,168 Bytes

Medicine: Telehealth (medne tele)

13,511 Bytes57,344 Bytes

Minor Consent Program (minor)

11,245 Bytes37,376 Bytes

Modifiers (modif)

39,419 Bytes258,560 Bytes

Modifiers: Approved List (modif app)

26,305 Bytes131,072 Bytes

Modifiers Used With Procedure Codes (modif used)

13,700 Bytes47,104 Bytes

Newborn Hearing Screening Program (newborn)

30,171 Bytes111,616 Bytes

Non-Injectable Drugs (non inject)

55,058 Bytes339,968 Bytes

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

50,379 Bytes84,992 Bytes

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

14,604 Bytes51,200 Bytes

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

33,802 Bytes130,560 Bytes

Ophthalmology (ophthal)

17,773 Bytes80,384 Bytes

Ophthalmology: Diagnosis Codes (ophthal cd)

33,168 Bytes132,608 Bytes

Optional Benefits Exclusion (opt ben exc)

10,989 Bytes36,864 Bytes

Osteopathic Manipulative Treatment (osteo)

16,266 Bytes54,784 Bytes

Other Health Coverage (OHC) (oth hlth)

12,701 Bytes49,152 Bytes

Other Health Coverage (OHC): CPT-4 and HCPCS Codes (oth hlth cpt)

20,838 Bytes79,360 Bytes

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

39,328 Bytes138,752 Bytes

Pathology: Billing and Modifiers (path bil)

106,845 Bytes159,232 Bytes

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

13,330 Bytes45,568 Bytes

Pathology: Blood Collection and Handling (path blood)

25,924 Bytes139,264 Bytes

Pathology: Chemistry (path chem)

14,534 Bytes52,736 Bytes

Pathology: Cytopathology (path cyto)

14,641 Bytes47,104 Bytes

Pathology: Drug Testing (path drug)

12,892 Bytes45,056 Bytes

Pathology: Immunology (path immun)

25,444 Bytes107,520 Bytes

Pathology: Microbiology (path micro)

79,096 Bytes500,224 Bytes

Pathology: Molecular Pathology (path molec)

18,211 Bytes73,216 Bytes

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

13,995 Bytes47,104 Bytes

Pathology: Surgical (path surg)

11,548 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)

18,774 Bytes71,680 Bytes

Podiatry Services (podi)

63,001 Bytes101,376 Bytes

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

22,163 Bytes80,384 Bytes

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

269,964 Bytes347,136 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)

12,661 Bytes44,032 Bytes

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

10,936 Bytes38,400 Bytes

Pregnancy Determination (preg determ)

33,866 Bytes134,656 Bytes

Pregnancy: Early Care and Diagnostic Services (preg early)

330,838 Bytes432,128 Bytes

Pregnancy Examples: UB-04 (preg ex ub)

11,633 Bytes38,912 Bytes

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

12,312 Bytes40,960 Bytes

Pregnancy: Global Billing (preg glo)

8,247 Bytes28,672 Bytes

Pregnancy: Global Billing Codes (preg glo cd)

10,144 Bytes33,792 Bytes

Pregnancy: Per-Visit Billing (preg per)

12,331 Bytes43,520 Bytes

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

15,072 Bytes50,176 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)

24,845 Bytes86,528 Bytes

Presumptive Eligibility for Pregnant Women (presum)

28,145 Bytes98,304 Bytes

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

28,145 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)

27,019 Bytes151,040 Bytes

Preventive Services (prev)

12,367 Bytes44,032 Bytes

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

19,941 Bytes69,632 Bytes

Psychiatry (psych)

21,551 Bytes81,408 Bytes

Radiology (radi)

160,798 Bytes221,184 Bytes

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

53,019 Bytes215,552 Bytes

Radiology: Diagnostic (radi dia)

15,131 Bytes56,320 Bytes

Radiology: Diagnostic Ultrasound (radi dia ult)

23,613 Bytes93,696 Bytes

Radiology: Nuclear Medicine (radi nuc)

23,770 Bytes84,480 Bytes

Radiology: Oncology (radi onc)

19,741 Bytes75,264 Bytes

Rates: Maximum Reimbursement (rates max)

8,602 Bytes29,696 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)

28,367 Bytes174,592 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)

28,546 Bytes111,616 Bytes

Respiratory Care (respir)

21,868 Bytes73,728 Bytes

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

23,801 Bytes110,080 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)

17,514 Bytes73,216 Bytes

Specialty Mental Health Services (spec)

19,640 Bytes109,568 Bytes

Specialty Mental Health Services: Eligible Counties (spec cnty)

17,263 Bytes67,584 Bytes

Speech Generating Devices (SGD) (spe dev)

1,715,948 Bytes1,876,480 Bytes

Sterilization (ster)

12,121 Bytes41,472 Bytes

Subacute Care Programs: Adult (subacut adu)

12,291 Bytes51,712 Bytes

Subacute Care Programs: Billing Codes (subacut code)

13,278 Bytes46,592 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)

17,235 Bytes64,000 Bytes

Subacute Care Programs: Pediatric (subacut ped)

10,613 Bytes34,816 Bytes

Supplies and Drugs (supp drug)

51,716 Bytes83,968 Bytes

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

11,372 Bytes39,936 Bytes

Supplies and Drugs for Outpatient Services (supp drug op)

23,194 Bytes80,384 Bytes

Surgery (surg)

18,744 Bytes60,416 Bytes

Surgery: Auditory System (surg aud)

244,600 Bytes334,848 Bytes

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

21,260 Bytes74,752 Bytes

Surgery: Billing With Modifiers (surg bil mod)

27,788 Bytes93,184 Bytes

Surgery: Cardiovascular System (surg cardio)

20,558 Bytes69,632 Bytes

Surgery: Digestive System (surg digest)

29,219 Bytes120,832 Bytes

Surgery: Eye and Ocular Adnexa (surg eye)

11,306 Bytes37,376 Bytes

Surgery: Female Genital System (surg female)

14,618 Bytes51,712 Bytes

Surgery: Integumentary System (surg integ)

9,607 Bytes32,256 Bytes

Surgery: Laparoscopy and Hysteroscopy (surg lap)

12,217 Bytes43,008 Bytes

Surgery: Male Genital System (surg male)

24,775 Bytes89,600 Bytes

Surgery: Musculoskeletal System (surg muscu)

28,113 Bytes105,472 Bytes

Surgery: Nervous System (surg nerv)

3,951 Bytes28,160 Bytes

Surgery: Room Reimbursement (surg room)

17,892 Bytes62,976 Bytes

Surgery: Urinary System (surg urin)

8,560 Bytes28,160 Bytes

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

17,245 Bytes70,144 Bytes

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

21,560 Bytes85,504 Bytes

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

27,677 Bytes113,664 Bytes

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

25,720 Bytes107,520 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)

22,696 Bytes89,088 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)

19,048 Bytes67,584 Bytes

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

31,643 Bytes119,808 Bytes

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

77,141 Bytes138,240 Bytes

TAR Completion (tar comp)

294,934 Bytes543,232 Bytes

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

29,977 Bytes124,416 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)

10,204 Bytes33,792 Bytes

Transgender Services (transgender)

24,727 Bytes100,352 Bytes

Transplants (transplant)

10,932 Bytes35,328 Bytes

Tuberculosis Program (tuber)

369,974 Bytes562,176 Bytes

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

25,187 Bytes62,976 Bytes

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

20,013 Bytes82,944 Bytes

UB-04 Submission and Timeliness Instructions (ub sub)

14,952 Bytes58,368 Bytes

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

33,921 Bytes141,312 Bytes

Vaccines For Children (VFC) Program (vaccine)



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