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Restored Outpatient Acupuncture Services for FQHC/RHC Providers

January 24, 2018

Effective retroactively for dates of service on or after July 1, 2016, outpatient acupuncture services for Federally Qualified Health Center and Rural Health Clinic (FQHC/RHC) providers are restored as acupuncture benefits provided to Medi-Cal recipients.

The following per-visit billing codes are restored (for dates of service through September 30, 2017):

Code Description
01 Medi-Cal per-visit code
15 Acupuncture
18 Managed care differential rate

Affected claims for dates of service on or after July 1, 2016, will be reprocessed with an Erroneous Payment Correction (EPC).

The following HIPAA-compliant code sets are available for billing on or after October 1, 2017:

Revenue Code Procedure Code Modifier Description
0521 T1015 N/A Medical Visit
2101 97810 SE Acupuncture Services
2101 97811 SE Acupuncture Services
2101 97813 SE Acupuncture Services
2101 97814 SE Acupuncture Services
0521 T1015 SE Managed Care Differential Rate

Providers will receive a 90 day timeliness override, effective the date of this publication, for billing acupuncture services for the dates of service described above.