Effective for dates of service on or after October 27, 2008, the Department of Health Care Services (DHCS) has determined the following:

• For procedure codes that contain both a technical and a professional (physician) component, the California Children’s Services (CCS) physician services supplemental rate increase should only be applied to the professional component.
• For procedure codes that do not constitute a physician service, the supplemental rate increase should not be applied.

Effective for dates of service on or after October 27, 2008, application of the supplemental rate increase will be restricted as follows:

• Procedure codes billed with surgical supply modifiers ZM and ZN will not receive the CCS increase, as these two modifiers are reimbursed for supply items and do not constitute a physician service
• Specific codes in the following table have no physician/professional component and will not receive the CCS increase

Procedure code	Description
77401	Radiation, treatment delivery, superficial and/or ortho voltage
77402	Radiation, treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; up to 5 MeV
77403	Radiation, treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 6 – 10 MeV
77404	Radiation, treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 11 – 19 MeV
77406	Radiation, treatment delivery, single treatment area, single port or parallel opposed ports, simple blocks or no blocks; 20 MeV or greater
77407	Radiation, treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; up to 5 MeV
77408	Radiation, treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 6 – 10 MeV
77409	Radiation, treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 11 – 19 MeV
77411	Radiation, treatment delivery, two separate treatment areas, three or more ports on a single treatment area, use of multiple blocks; 20 MeV or greater
77412	Radiation treatment delivery, three or more separate treatment areas, custom blocking, targential ports, wedges, rotational beam, compensators, electron beam; up to 5 MeV
77413	Radiation treatment delivery, three or more separate treatment areas, custom blocking, targential ports, wedges, rotational beam, compensators, electron beam; 6 – 10 MeV
77414	Radiation treatment delivery, three or more separate treatment areas, custom blocking, targential ports, wedges, rotational beam, compensators, electron beam; 11 – 19 MeV
77416	Radiation treatment delivery, three or more separate treatment areas, custom blocking, targential ports, wedges, rotational beam, compensators, electron beam; 20 MeV or greater
77520	Proton treatment delivery; simple, without compensation
77522	Proton treatment delivery; simple, with compensation
77523	Proton treatment delivery; intermediate
77525	Proton treatment delivery; complex
81025	Urine pregnancy test, by visual color comparison methods
83013	Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope
88184	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker
88185	Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker
88400	Bilirubin, total, transcutaneous
89055	Leukocyte assessment, fecal, qualitative or semiquantitative

Note:

Procedure codes 70000 – 89999 that have a professional component (physician) will receive the CCS supplemental increase only for the professional (physician)component.

Procedure codes billed with the modifiers in the following table will be priced as specified in the table:

Modifier	CCS Increase Description
26 – Professional component	No impact: Claims will receive the full CCS supplemental increase.
22 – Unusual Service 25 – Significantly separately identifiable E&M – same provider and date of service 59 – Separately identifiable service 78 – Return to operating room 79 – Unrelated procedure or service 90 – Reference (outside) Laboratory ET – Emergency Services QW – CLIA waived test SA – Nurse Practitioner SC – Medically necessary service ZS – Professional and Technical Component	Claims will receive the CCS supplemental increase on the physician/professional component of the procedure only.
TC – Technical component	Claims will not receive the CCS supplemental increase.
All other modifiers	No impact: Claims will receive the full CCS supplemental increase.