CHDP HIPAA Code Conversion for Clinical Laboratory Service Providers Coming Soon
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.
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.
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|
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.