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

7,265 Bytes49,152 Bytes

Manual Organization (0Amanorg)

22,227 Bytes84,992 Bytes

How to Use This Manual (0Bhwtouse)

19,786 Bytes80,384 Bytes

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

17,776 Bytes68,608 Bytes

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

18,444 Bytes69,120 Bytes

Abortions (abort)

15,598 Bytes59,392 Bytes

Allergy Testing and Desensitization (allergy)

13,074 Bytes46,592 Bytes

Alternative Birthing Centers (altern)

39,080 Bytes151,552 Bytes

Anesthesia (anest)

188,846 Bytes267,776 Bytes

Anesthesia Billing Examples: UB-04 (anest ub)

110,276 Bytes161,792 Bytes

Appeal Form Completion (appeal form)

22,436 Bytes86,016 Bytes

Blood and Blood Derivatives (blood)

101,485 Bytes157,696 Bytes

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

15,469 Bytes51,712 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)

6,830 Bytes35,328 Bytes

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

6,747 Bytes38,912 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)

10,560 Bytes49,664 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)

25,051 Bytes97,280 Bytes

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

64,305 Bytes314,368 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)

30,651 Bytes123,904 Bytes

Cardiology (cardio)

83,105 Bytes117,760 Bytes

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

18,385 Bytes78,848 Bytes

Chemotherapy: An Overview (chemo an over)

40,380 Bytes175,104 Bytes

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

34,709 Bytes141,312 Bytes

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

34,920 Bytes152,576 Bytes

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

9,487 Bytes32,256 Bytes

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

125,697 Bytes212,992 Bytes

CIF Completion (cif co)

115,215 Bytes173,568 Bytes

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

63,483 Bytes100,352 Bytes

CIF Submission and Timeliness Instructions (cif sub)

89,339 Bytes174,080 Bytes

Contracted and Non-Contracted Inpatient Services (cont ip)

17,209 Bytes68,096 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)

10,073 Bytes36,864 Bytes

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

20,493 Bytes80,896 Bytes

Dialysis: Chronic Dialysis Services (dial chr)

14,061 Bytes48,128 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)

21,964 Bytes79,872 Bytes

Drug Use Review (DUR) Program (drug)

52,764 Bytes607,232 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)

38,334 Bytes167,936 Bytes

Evaluation & Management (E&M) (eval)

50,756 Bytes263,680 Bytes

Every Woman Counts (ev woman)

55,984 Bytes93,696 Bytes

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

23,250 Bytes82,944 Bytes

Family Planning (fam planning)

156,205 Bytes220,160 Bytes

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

13,403 Bytes44,032 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,276 Bytes31,744 Bytes

Forms Reorder Request: Guidelines (forms reo)

35,141 Bytes72,704 Bytes

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

17,941 Bytes59,904 Bytes

Genetic Counseling and Screening (gene coun)

28,642 Bytes112,640 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

10,028 Bytes34,816 Bytes

HCPCS Introduction (hcpcs)

10,838 Bytes57,856 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)

18,271 Bytes61,440 Bytes

Hospice Care (hospic)

18,712 Bytes90,112 Bytes

Hysterectomy (hyst)

34,365 Bytes140,288 Bytes

Immunizations (immun)

11,157 Bytes37,376 Bytes

Immunizations Code List (immun cd)

25,300 Bytes105,984 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

17,446 Bytes60,928 Bytes

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

20,275 Bytes101,888 Bytes

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

15,990 Bytes67,072 Bytes

Injections: An Overview (inject an over)

56,409 Bytes93,184 Bytes

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

30,718 Bytes110,080 Bytes

Injections: Code List (inject cd list)

47,610 Bytes188,928 Bytes

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

50,662 Bytes205,824 Bytes

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

29,347 Bytes102,400 Bytes

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

32,442 Bytes113,664 Bytes

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

37,350 Bytes138,240 Bytes

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

9,650 Bytes38,400 Bytes

Injections: Hydration (inject hydra)

40,185 Bytes164,352 Bytes

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

818,677 Bytes968,192 Bytes

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

36,386 Bytes195,584 Bytes

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

4,725 Bytes29,696 Bytes

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

10,327 Bytes46,080 Bytes

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

14,747 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)

29,823 Bytes116,224 Bytes

Medicine (medne)

17,614 Bytes67,584 Bytes

Medicine: Neurology and Neuromuscular (medne neu)

13,142 Bytes44,032 Bytes

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

12,216 Bytes44,032 Bytes

Medicine: Otorhinolaryngologic Services (medne oto)

12,871 Bytes46,080 Bytes

Medicine: Pulmonary (medne pul)

19,337 Bytes68,096 Bytes

Medicine: Telehealth (medne tele)

12,779 Bytes57,344 Bytes

Minor Consent Program (minor)

10,719 Bytes35,328 Bytes

Modifiers (modif)

35,134 Bytes254,976 Bytes

Modifiers: Approved List (modif app)

25,624 Bytes128,000 Bytes

Modifiers Used With Procedure Codes (modif used)

13,700 Bytes47,104 Bytes

Newborn Hearing Screening Program (newborn)

23,185 Bytes87,040 Bytes

Non-Injectable Drugs (non inject)

50,337 Bytes312,320 Bytes

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

47,751 Bytes79,872 Bytes

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

13,562 Bytes47,104 Bytes

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

34,910 Bytes144,384 Bytes

Ophthalmology (ophthal)

17,644 Bytes82,944 Bytes

Ophthalmology: Diagnosis Codes (ophthal cd)

31,148 Bytes132,608 Bytes

Optional Benefits Exclusion (opt ben exc)

14,889 Bytes52,736 Bytes

Other Health Coverage (OHC) (oth hlth)

11,907 Bytes48,640 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)

32,039 Bytes120,832 Bytes

Pathology: Billing and Modifiers (path bil)

103,764 Bytes154,624 Bytes

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

12,972 Bytes46,080 Bytes

Pathology: Blood Collection and Handling (path blood)

24,501 Bytes131,072 Bytes

Pathology: Chemistry (path chem)

14,292 Bytes52,224 Bytes

Pathology: Cytopathology (path cyto)

14,864 Bytes48,128 Bytes

Pathology: Drug Testing (path drug)

12,292 Bytes44,032 Bytes

Pathology: Immunology (path immun)

23,511 Bytes96,256 Bytes

Pathology: Microbiology (path micro)

55,502 Bytes315,392 Bytes

Pathology: Molecular Pathology (path molec)

17,856 Bytes71,680 Bytes

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

13,708 Bytes46,592 Bytes

Pathology: Surgical (path surg)

9,873 Bytes33,792 Bytes

Pathology: Urinalysis (path urin)

11,654 Bytes39,936 Bytes

Physician-Administered Drugs: NDC (physician ndc)

18,357 Bytes58,880 Bytes

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

17,128 Bytes68,096 Bytes

Podiatry Services (podi)

60,371 Bytes96,768 Bytes

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

21,283 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)

9,789 Bytes34,304 Bytes

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

8,140 Bytes28,160 Bytes

Pregnancy Determination (preg determ)

33,808 Bytes140,288 Bytes

Pregnancy: Early Care and Diagnostic Services (preg early)

326,812 Bytes428,544 Bytes

Pregnancy Examples: UB-04 (preg ex ub)

11,286 Bytes37,888 Bytes

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

11,747 Bytes40,960 Bytes

Pregnancy: Global Billing (preg glo)

7,837 Bytes46,592 Bytes

Pregnancy: Global Billing Codes (preg glo cd)

9,787 Bytes33,280 Bytes

Pregnancy: Per-Visit Billing (preg per)

8,643 Bytes30,208 Bytes

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

13,212 Bytes46,592 Bytes

Pregnancy: Postpartum and Newborn Referral Services (preg post)

7,356 Bytes45,056 Bytes

Pregnancy: Share of Cost (preg share)

17,391 Bytes77,824 Bytes

Prescription Referrals (prescript)

9,081 Bytes32,768 Bytes

Prescription Referrals: Vision Care (prescript vc)

39,684 Bytes141,312 Bytes

Presumptive Eligibility for Pregnant Women (presum)

9,494 Bytes30,720 Bytes

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

12,668 Bytes40,448 Bytes

Form: Directions to Apply for Medi-Cal (presum cdir app)

7,565 Bytes25,600 Bytes

Form: Patient Directions For Presumptive Eligibility For Pregnant Women Program Application (presum e pat dir)

5,385 Bytes37,376 Bytes

Form: Instrucciones para el Paciente para la Solicitud de Elegibilidad Presunta

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)

10,578 Bytes38,400 Bytes

Form: Statement of California Residency (presumireside)

5,528 Bytes27,136 Bytes

Form: Declaracion de Residencia en California

8,419 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)

17,507 Bytes65,024 Bytes

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

10,170 Bytes37,888 Bytes

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

11,108 Bytes56,832 Bytes

Form: Weekly Presumptive Eligibility (PE) For Pregnant Women Enrollment Summary MC 283 (presum week summ)

16,411 Bytes56,320 Bytes

Preventive Services (prev)

11,854 Bytes43,520 Bytes

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

19,445 Bytes70,144 Bytes

Psychiatry (psych)

20,149 Bytes79,360 Bytes

Radiology (radi)

156,647 Bytes216,064 Bytes

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

45,471 Bytes204,288 Bytes

Radiology: Diagnostic (radi dia)

13,955 Bytes52,224 Bytes

Radiology: Diagnostic Ultrasound (radi dia ult)

19,553 Bytes79,360 Bytes

Radiology: Nuclear Medicine (radi nuc)

23,216 Bytes83,456 Bytes

Radiology: Oncology (radi onc)

18,545 Bytes77,824 Bytes

Rates: Maximum Reimbursement (rates max)

8,410 Bytes29,184 Bytes

Rates: Maximum Reimbursement for Laboratories (rates max lab)

8,650 Bytes48,128 Bytes

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

10,070 Bytes52,224 Bytes

Remittance Advice Details (RAD) (remit adv)

28,129 Bytes183,296 Bytes

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

10,322 Bytes35,328 Bytes

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

17,625 Bytes69,120 Bytes

Respiratory Care (respir)

690,784 Bytes803,328 Bytes

Resubmission Turnaround Document (RTD) Completion (resub comp)

19,160 Bytes63,488 Bytes

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

23,565 Bytes110,592 Bytes

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

256,147 Bytes371,712 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)

11,715 Bytes45,056 Bytes

Sign Language Interpretation (sign)

16,566 Bytes71,680 Bytes

Specialty Mental Health Services (spec)

19,640 Bytes109,568 Bytes

Specialty Mental Health Services: Eligible Counties (spec cnty)

16,113 Bytes67,584 Bytes

Speech Generating Devices (SGD) (spe dev)

1,259,574 Bytes1,419,264 Bytes

Sterilization (ster)

11,489 Bytes41,984 Bytes

Subacute Care Programs: Adult (subacut adu)

13,562 Bytes64,512 Bytes

Subacute Care Programs: Billing Codes (subacut code)

13,070 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)

16,111 Bytes63,488 Bytes

Subacute Care Programs: Pediatric (subacut ped)

10,513 Bytes34,816 Bytes

Supplies and Drugs (supp drug)

50,955 Bytes83,456 Bytes

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

10,515 Bytes38,400 Bytes

Supplies and Drugs for Outpatient Services (supp drug op)

18,272 Bytes65,024 Bytes

Surgery (surg)

12,720 Bytes43,008 Bytes

Surgery: Auditory System (surg aud)

242,149 Bytes330,752 Bytes

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

20,476 Bytes72,192 Bytes

Surgery: Billing With Modifiers (surg bil mod)

22,298 Bytes76,800 Bytes

Surgery: Cardiovascular System (surg cardio)

15,841 Bytes56,320 Bytes

Surgery: Digestive System (surg digest)

26,931 Bytes118,272 Bytes

Surgery: Eye and Ocular Adnexa (surg eye)

10,680 Bytes36,864 Bytes

Surgery: Female Genital System (surg female)

13,736 Bytes51,200 Bytes

Surgery: Integumentary System (surg integ)

7,402 Bytes26,624 Bytes

Surgery: Laparoscopy and Hysteroscopy (surg lap)

8,719 Bytes30,208 Bytes

Surgery: Male Genital System (surg male)

20,949 Bytes81,408 Bytes

Surgery: Musculoskeletal System (surg muscu)

24,701 Bytes98,304 Bytes

Surgery: Nervous System (surg nerv)

3,951 Bytes28,160 Bytes

Surgery: Room Reimbursement (surg room)

15,933 Bytes58,368 Bytes

Surgery: Urinary System (surg urin)

8,056 Bytes27,648 Bytes

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

16,491 Bytes66,048 Bytes

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

20,403 Bytes86,016 Bytes

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

26,675 Bytes108,032 Bytes

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

24,315 Bytes108,032 Bytes

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

23,171 Bytes98,816 Bytes

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

22,556 Bytes88,576 Bytes

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

12,190 Bytes46,592 Bytes

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

16,132 Bytes55,296 Bytes

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

27,301 Bytes108,032 Bytes

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

122,667 Bytes191,488 Bytes

TAR Completion (tar comp)

294,934 Bytes543,232 Bytes

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

27,811 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)

9,534 Bytes32,768 Bytes

Transgender Services (transgender)

22,815 Bytes96,768 Bytes

Transplants (transplant)

10,932 Bytes35,328 Bytes

Tuberculosis Program (tuber)

363,724 Bytes553,984 Bytes

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

24,781 Bytes61,952 Bytes

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

20,137 Bytes83,456 Bytes

UB-04 Submission and Timeliness Instructions (ub sub)

14,623 Bytes56,320 Bytes

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

30,396 Bytes127,488 Bytes

Vaccines For Children (VFC) Program (vaccine)



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