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Family PACT Claims Erroneously Denied with RAD Codes 0169, 9515 and 9516

February 23, 2018

The Department of Health Care Services (DHCS) has identified a claims processing issue that occurred on or after January 1, 2018, causing Family Planning, Access, Care and Treatment (Family PACT) claims to erroneously deny with Remittance Advice Details (RAD) codes 0169: This service is not payable when billed with this diagnosis, 9515: The procedure code is not a benefit of the Family PACT (Planning, Access, Care and Treatment) program and 9516: The secondary diagnosis code is missing or invalid for the procedure code. DHCS and the DHCS Fiscal Intermediary (FI) are working to resolve this issue.

Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.