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Proposition 56 Supplemental Payment for Physician Services

December 28, 2017

On December 6, 2017, the Department of Health Care Services (DHCS) received the Centers for Medicare & Medicaid Services (CMS) approval of State Plan Amendment (SPA) 17-030. SPA 17-030 authorizes a one-year (from July 1, 2017 through June 30, 2018) supplemental payment for certain physician services, funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) and matching federal funds. Supplemental payments for the impacted physician services will be made based on claim submissions for specific Current Procedural Terminology – 4th Edition (CPT-4) codes as follows:

CPT-4 Codes Supplemental Payment
90863 $  5.00
99201, 99211 10.00
99202, 99212, 99213 15.00
99203, 99204, 99214, 99215 25.00
90791, 90792 35.00
99205 50.00

Providers may refer to the Proposition 56 Supplemental Payment Methodologies PDF on the DHCS website for more information regarding Proposition 56 and supplemental payments for physician services.