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Claims with Telehealth Modifier 95 Erroneously Denied

January 27, 2020

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting Local Educational Agency (LEA) claims. This issue caused claims billed with modifier 95 to erroneously deny. This issue affects claims with dates of service on or after July 1, 2019.

No action is required of providers. DHCS and the California MMIS Fiscal Intermediary 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.