Providers eligible to bill CPT-4 codes 99201 – 99205 (office or other outpatient visit for the evaluation and management of a new patient) and 99211 – 99215 (office or other outpatient visit for the evaluation and management of an established patient) may bill for medically necessary services related to non-routine problems associated with breast feeding using the infant’s Medi-Cal ID number. The infant must be present at the time the service is rendered.

The ICD-9-CM diagnosis code on the claim should be a specific diagnosis of the infant. An example would be ICD-9-CM code 750.0 (tongue tie). Providers are reminded that, of the CPT-4 codes listed above, only 99211 (office or other outpatient visit for the evaluation and management of an established patient [may not require the presence of a physician]) should be billed if the service is not rendered by a physician or a Non-physician Medical Practitioner. (The term “Non-physician Medical Practitioner” includes a physician assistant, a nurse practitioner or a certified nurse midwife).