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CHDP HIPAA Code Conversion for Clinical Laboratory Service Providers Coming Soon

October 26, 2016

Child Health and Disability Prevention (CHDP) participating providers who bill for clinical laboratory services only will start billing lab services according to HIPAA national standards for dates of service on or after February 1, 2017. The transition from billing clinical laboratory services with local two-character CHDP codes on the PM 160 to billing national codes on the CMS-1500 or UB-04, or electronic equivalents will be based on a date of service cutover.

Phased Approach
Transitioning lab providers to submit national CPT-4 codes on CMS-1500, UB-04 or equivalent electronic claims is the first phase of an overall CHDP code conversion. The second phase will transition CHDP providers who render well health assessments, immunizations and lab services in a single encounter to billing with the national claim formats.

CPT-4 Codes
For services rendered for dates of service on or after February 1, 2017, CHDP clinical laboratory-only providers may submit their claims on the CMS-1500, UB-04 or via the equivalent electronic claim. Medi-Cal billing will be based on providers’ enrollment status with Medi-Cal.

CPT-4 Code   Description CHDP Code CHDP Description
80061 Lipid panel B2 Dyslipidemia screening
81000 Urinalysis, by dip stick or tablet reagent 9 Urine dipstick
81005 Urinalysis; qualitative or semiquanti-tative, except immunoassays 10 Analysis of urine
82947 Glucose; quantitative, blood, (except reagent strip) 25 Blood glucose assay
83020 Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 13 Sickle cell: Electrophoresis
83655 Blood lead 23 Lead test – Lead counseling and blood drawing for lead testing
15 Lead: Blood lead level types
85018 Blood count; hemoglobin (Hgb) 8 Hemoglobin measurement
86580 Skin test; tuberculosis, intradermal 12 TB mantoux
86592 Syphilis test, non-treponemal antibody; qualitative (eg. VDRL, RPR, ART) 16 Syphilis detection test
86703 HIV-1 and HIV-2, single result B5 HIV-1 and HIV-2 screening
87070 Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 17 Gonorrhea (GC) test
87110 Culture, chlamydia, any source 20 Chlamydia test
87389 HIV-1 antigen[s], with HIV-1 and HIV-2 antibodies, single result B6 HIV screening (HIV-1 antigen[s], with HIV-1 and HIV-2 antibodies, single result)
99000 Handling and/or conveyance of specimen for transfer from the office to a laboratory HC Handling charge
Note:

This may not be a comprehensive list and is subject to change prior to the effective date of the transition.

Important Facts for CHDP Clinical Laboratory-Only Providers

  • All CHDP lab service providers must have an active Medi-Cal NPI.
  • Services will be billed in conformance with the HIPAA standard transactions and code sets.
  • Claims will be submitted on standard claim forms: CMS-1500, UB-04 and equivalent electronic claims.
  • Providers will bill according to Medi-Cal hard copy and electronic claim submission standards.
  • Reimbursement for services will be at the Medi-Cal rate. The Medi-Cal rate table may be accessed from the Medi-Cal website: Under the References tab click on “Medi-Cal Rates.”
  • Payment will be made on providers’ Medi-Cal warrant for claims processed with dates of service on or after February 1, 2017.
  • For any services rendered for dates of service prior to February 1, 2017, providers will continue to submit claims on the Confidential Screening/Billing Report (PM 160) claim form.
  • It is recommended that providers bill electronically for all its many benefits. Providers who may not be able to bill electronically and do not have a supply of national claim forms should order in advance. Delivery of forms does take time. Providers should work with a credible vendor and purchase forms with “drop-out” ink that meets Centers for Medicare and Medicaid (CMS) standards.

Providers are strongly encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to this code crosswalk and transition to national billing formats. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Additional details regarding this transition will be announced in a future NewsFlash and/or CHDP Update.

Email Address for Questions/Concerns
Providers may submit questions or concerns regarding the CHDP clinical laboratory-only transition to CHDPTransition@xerox.com.