Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Additional Instructions for PE for COVID-19 and PE for Pregnant Women Aid Code 7F

Originally published April 23, 2020 and updated on April 24, 2020

Effective for dates on or after April 8, 2020, the Presumptive Eligibility (PE) for Coronavirus (COVID-19) Program was implemented. PE for COVID-19 uses new aid code V2 to identify this population. As such, the Department of Health Care Services (DHCS) wants to ensure that Qualified Providers (QPs) for the Presumptive Eligibility for Pregnant Women (PE4PW) are informed of the following changes.

If an individual requests pregnancy services and COVID-19 diagnostic testing, testing-related services, and treatment services, including all medically necessary care related to COVID-19, QPs shall continue to evaluate the individual for the PE4PW program. If the individual is approved for aid code 7F (PE – Pregnancy Verification), the QP should resubmit the application and report the following household size and income to indicate that the application is approved for PE COVID-19:

  • Income: 99,999/monthly
  • Household size: 98

Once the individual is enrolled into the PE for COVID-19, the PE for COVID-19 aid code will overlay the PE4PW aid code, 7F, with the same effective date. Providers are to render the COVID-19 diagnostic testing, testing-related services and treatment services, including all medically necessary care related to COVID-19 for the individual at the time of the individual’s visit to the office, clinic or hospital.

QPs should refer to the Presumptive Eligibility (PE) for Coronavirus (COVID-19) FAQ for additional information. Questions concerning PE for COVID-19 should be sent to COVID19Apps@dhcs.ca.gov.

Billing Instructions for PE for COVID-19 were published on April 24, 2020.