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

Part 2 – Pharmacy

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)

16,347 Bytes59,904 Bytes

Contents (Part 2 – Medi-Cal Billing and Policy): Pharmacy (2toc pharm)

110,276 Bytes161,792 Bytes

Appeal Form Completion (appeal form)

22,155 Bytes85,504 Bytes

Blood and Blood Derivatives (blood)

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)

458,832 Bytes524,800 Bytes

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

6,747 Bytes38,912 Bytes

CCS Program Billing Guidelines (cal child bil guide)

766,481 Bytes809,984 Bytes

California Children's Services (CCS) Program Billing Example: Pharmacy Claim Forms (cal child bil ph)

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)

24,085 Bytes94,720 Bytes

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

66,879 Bytes322,560 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)

9,487 Bytes32,256 Bytes

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

125,697 Bytes212,992 Bytes

CIF Completion (cif co)

101,943 Bytes161,792 Bytes

CIF Special Billing Instructions (cif sp)

63,483 Bytes100,352 Bytes

CIF Submission and Timeliness Instructions (cif sub)

558,721 Bytes710,144 Bytes

CMS-1500 Completion (cms comp)

193,373 Bytes253,440 Bytes

CMS-1500 Special Billing Instructions (cms spec)

17,802 Bytes76,288 Bytes

CMS-1500 Submission and Timeliness Instructions (cms sub)

11,087 Bytes68,096 Bytes

CMS-1500 Tips for Billing (cms tips)

76,426 Bytes152,576 Bytes

Compound Drug Pharmacy Claim Form (30-4) Completion (compound comp)

179,129 Bytes226,816 Bytes

Compound Pharmacy Claim Form (30-4) Examples (compound ex)

21,964 Bytes79,872 Bytes

Drug Use Review (DUR) Program (drug)

9,807 Bytes34,816 Bytes

Drugs: Contract Drugs List Introduction (drugs cdl intr)

88,292 Bytes497,664 Bytes

Drugs: Contract Drugs List Part 1 – Prescription Drugs (A through D) (drugs cdl p1a)

96,960 Bytes543,232 Bytes

Drugs: Contract Drugs List Part 1 – Prescription Drugs (E through M) (drugs cdl p1b)

70,911 Bytes373,248 Bytes

Drugs: Contract Drugs List Part 1 – Prescription Drugs (N through R) (drugs cdl p1c)

52,144 Bytes258,048 Bytes

Drugs: Contract Drugs List Part 1 – Prescription Drugs (S through Z) (drugs cdl p1d)

30,199 Bytes147,456 Bytes

Drugs: Contract Drugs List Part 2 – Over-the-Counter Drugs (drugs cdl p2)

14,569 Bytes58,880 Bytes

Drugs: Contract Drugs List Part 3 – Over-the-Counter Cold/Cough Preparations (drugs cdl p3)

38,926 Bytes147,968 Bytes

Drugs: Contract Drugs List Part 4 – Therapeutic Classifications (drugs cdl p4)

55,491 Bytes602,112 Bytes

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

18,628 Bytes78,848 Bytes

Drugs: Contract Drugs List Part 6 – Deleted Drugs (drugs cdl p6)

5,934 Bytes41,472 Bytes

Drugs: Contract Drugs List Part 7 - Preferred TAR-Approved Drug List (drugs cdl p7)

11,375 Bytes44,032 Bytes

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

18,231 Bytes73,728 Bytes

Drugs: Contract Drugs List Part 10 – MAIC List (drugs cdl pa10)

6,641 Bytes31,232 Bytes

Drugs: MAIC Rate Review (drugs maic rate)

16,012 Bytes77,824 Bytes

Form: California MAIC Rate Review Application (CAMRRA) (MC 3150)

30,913 Bytes107,520 Bytes

Durable Medical Equipment (DME): An Overview (dura)

99,820 Bytes122,368 Bytes

Form: Certificate of Medical Necessity for All Durable Medical Equipment (DME) (Except Wheelchairs and Scooters) (DHS 6181)

7,333 Bytes40,448 Bytes

Form: Certificate of Medical Necessity for Apnea Monitors (MC 4600)

7,182 Bytes41,472 Bytes

Form: Certificate of Medical Necessity for Nebulizers (MC 4601)

7,693 Bytes44,032 Bytes

Form: Certificate of Medical Necessity for Oxygen (MC 4602)

58,299 Bytes235,008 Bytes

Durable Medical Equipment (DME): Bill for DME (dura bil dme)

16,369 Bytes57,344 Bytes

Durable Medical Equipment (DME): Bill for Infusion Equipment (dura bil inf)

44,587 Bytes222,720 Bytes

Durable Medical Equipment (DME): Bill for Oxygen and Respiratory Equipment (dura bil oxy)

53,807 Bytes269,824 Bytes

Durable Medical Equipment (DME): Bill for Therapeutic Anti-Decubitus Mattresses and Bed Products (dura bil thp)

25,474 Bytes101,888 Bytes

Durable Medical Equipment (DME): Bill for Wheelchairs and Wheelchair Accessories (dura bil wheel)

274,925 Bytes352,256 Bytes

Form: Certificate of Medical Necessity for a Manual Wheelchair, Standard or Custom (DHS 6181-A)

282,134 Bytes359,424 Bytes

Form: Certificate of Medical Necessity for a Motorized Wheelchair, Custom or Standard (DHS 6181-B)

249,872 Bytes330,240 Bytes

Form: Certificate of Medical Necessity for a Power Operated Vehicle (POV) aka Scooter, Standard or Bariatric (DHS 6181-C)

80,782 Bytes701,952 Bytes

Durable Medical Equipment (DME): Billing Codes and Reimbursement Rates (dura cd)

10,071 Bytes40,448 Bytes

Durable Medical Equipment (DME): Billing Codes for California Children's Services (CCS) (dura cd ccs)

18,357 Bytes98,816 Bytes

Durable Medical Equipment (DME) Billing Codes: Frequency Limits (dura cd fre)

4,034,713 Bytes4,481,024 Bytes

Durable Medical Equipment (DME): Billing Examples (dura ex)

43,172 Bytes169,984 Bytes

Durable Medical Equipment (DME): Wheelchair and Wheelchair Accessories Guidelines (dura wheel guide)

28,462 Bytes131,584 Bytes

End of Life Option Act Services (eloa)

978,450 Bytes1,127,936 Bytes

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

34,595 Bytes167,424 Bytes

Enteral Nutrition Products (enteral)

13,403 Bytes44,032 Bytes

Forms: Legibility and Completion Standards (forms leg)

9,276 Bytes31,744 Bytes

Forms Reorder Request: Guidelines (forms reo)

35,762 Bytes56,320 Bytes

Forms Reorder Request: Pharmacy (forms reo ph)

29,441 Bytes113,152 Bytes

Genetically Handicapped Persons Program (GHPP) (genetic)

36,563 Bytes139,776 Bytes

Immunizations (immun)

11,472 Bytes37,376 Bytes

Immunizations Code List (immun cd)

25,300 Bytes105,984 Bytes

Incontinence Medical Supplies (incont)

449,806 Bytes521,216 Bytes

Incontinence Medical Supplies Example: CMS-1500 (incont ex)

13,992 Bytes87,040 Bytes

Incontinence Supplies Prescription Form: Completion (incont sup com)

7,770 Bytes53,248 Bytes

Form: Incontinence Supplies Prescription Form

15,990 Bytes67,072 Bytes

Injections: An Overview (inject an over)

29,758 Bytes105,984 Bytes

Injections: Code List (inject cd list)

45,950 Bytes185,856 Bytes

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

46,189 Bytes181,248 Bytes

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

31,349 Bytes122,880 Bytes

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

31,706 Bytes111,104 Bytes

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

35,072 Bytes128,000 Bytes

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

6,843 Bytes38,912 Bytes

Injections: Hydration (inject hydra)

11,442 Bytes44,544 Bytes

Intravenous or Intra-arterial Solutions: Administration Sets (iv sol admin)

14,866 Bytes54,784 Bytes

Intravenous or Intra-arterial Solutions: Special Billing (iv sol spec)

22,683 Bytes94,208 Bytes

Medical Supplies (mc sup)

469,992 Bytes576,000 Bytes

Medical Supplies: Billing Examples (mc sup ex)

8,444 Bytes47,616 Bytes

Medicare Covered Drugs (medicare drugs)

33,043 Bytes130,560 Bytes

Medicare/Medi-Cal Crossover Claims: Pharmacy Services (medi cr ph)

3,071,914 Bytes3,316,224 Bytes

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

45,038 Bytes280,064 Bytes

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

14,943 Bytes68,608 Bytes

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

31,148 Bytes132,608 Bytes

Optional Benefits Exclusion (opt ben exc)

34,258 Bytes139,264 Bytes

Orthotic and Prosthetic Appliances (ortho)

8,743 Bytes32,256 Bytes

Form: Physician Certification of Medical Necessity for Therapeutic Diabetic Shoes and Inserts (ortho 1 form)

57,284 Bytes505,856 Bytes

Orthotic and Prosthetic Appliances: Billing Codes and Reimbursement Rates – Orthotics (ortho cd1)

41,668 Bytes355,840 Bytes

Orthotic and Prosthetic Appliances: Billing Codes and Reimbursement Rates – Prosthetics (ortho cd2)

13,649 Bytes57,344 Bytes

Orthotics and Prosthetics: Frequency Limits for Orthotics (ortho cd fre1)

12,374 Bytes51,712 Bytes

Orthotics and Prosthetics: Frequency Limits for Prosthetics (ortho cd fre2)

1,281,931 Bytes1,441,792 Bytes

Orthotic and Prosthetic Appliances: Billing Examples (ortho ex)

14,889 Bytes52,736 Bytes

Other Health Coverage (OHC) (oth hlth)

84,779 Bytes151,040 Bytes

Pharmacy Claim Form (30-1) Completion (pcf30-1 comp)

2,305,228 Bytes2,393,600 Bytes

Pharmacy Claim Form (30-1) Examples (pcf30-1 ex)

15,389 Bytes48,640 Bytes

Pharmacy Claim Form (30-1): Special Billing Instructions (pcf30-1 spec)

16,234 Bytes65,536 Bytes

Pharmacy Claim Form (30-1): Submission and Timeliness Instructions (pcf30-1 sub)

14,919 Bytes57,344 Bytes

Pharmacy Claim Form (30-1) Tips (pcf30-1 tips)

36,650 Bytes137,728 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)

10,186 Bytes37,376 Bytes

Form: Form Order Presumptive Eligibility (PE) For Pregnant Women Program (presumdfmordr)

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)

11,854 Bytes43,520 Bytes

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

25,016 Bytes95,232 Bytes

Reimbursement (reimbursement)

19,041 Bytes105,472 Bytes

Reject Codes for Real-Time Internet Pharmacy (RTIP) (reject cd)

18,930 Bytes107,008 Bytes

Reject Codes for Medi-Cal-Supplied POS Device (reject cd pos)

10,070 Bytes52,224 Bytes

Remittance Advice Details (RAD) (remit adv)

25,300 Bytes164,864 Bytes

Remittance Advice Details (RAD) Examples: Pharmacy (remit ex ph)

10,322 Bytes35,328 Bytes

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

690,784 Bytes803,328 Bytes

Resubmission Turnaround Document (RTD) Completion (resub comp)

32,200 Bytes173,056 Bytes

Share of Cost (SOC): 30-1 for Pharmacy (share ph)

11,715 Bytes45,056 Bytes

Sign Language Interpretation (sign)

11,489 Bytes41,984 Bytes

Subacute Care Programs: Adult (subacut adu)

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)

122,667 Bytes191,488 Bytes

TAR Completion (tar comp)

294,934 Bytes543,232 Bytes

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

27,549 Bytes122,368 Bytes

TAR Field Office Addresses (tar field)

48,903 Bytes97,280 Bytes

TAR Submission: Drug TARs (tar sub drug)

104,194 Bytes151,552 Bytes

TAR Submission: Transmittal Form (tar submis)

10,532 Bytes33,792 Bytes

TAR: Submitting Appeals (tar submit)

30,056 Bytes188,928 Bytes

Taxable and Non-Taxable Items (tax)



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