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Medi-Cal Rates Conversion Factors


Medi-Cal Rates as of 01/15/2019

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month


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Conversion Indicators and Conversion Factors Used to Calculate Maximum Rates (as of Medi-Cal Rates as of 01/15/2019)

Conversion Indicators on Rate Worksheet Physician,Hospital Outpatient Dept,etc.(Provider Type=05, 07, 15, 22, 26, 28, 56, 61) Place of Service=Emergency Room (If ER Indicator="1") Free,Community & County Clinic (P/T=40, 41, 48, 58) Other Clinic (P/T=42, 43, 44, 45, 46, 50) Podiatrist (P/T=27) Nurse Anesthetist (P/T=18)
Conv Ind Patient Age Service Type Conv Ind Conv Factor Conv Ind Conv Factor Conv Ind Conv Factor Conv Ind Conv Factor Conv Ind Conv Factor Conv Ind Conv Factor
001 ADULT PRIMARY CARE I 001 $10.00 056 $12.42 011 $12.38 022 $10.59 -- -- -- --
001 CHILD PRIMARY CARE I 045 $10.91 056 $12.42 043 $13.59 044 $11.50 -- -- -- --
002 ALL ANESTHESIOLOGY 002 $14.01 -- -- 028 $14.71 028 $14.71 -- -- 013 $11.02
003 ALL OB (C-SECTION) 003 $82.16 -- -- 024 $86.29 024 $86.29 -- -- -- --
004 ALL OTHER SURGERY 004 $37.23 018 $46.95 025 $39.10 025 $39.10 -- -- 004 $37.23
004 ALL SURGERY (LAPAROSCOPY GYN) 016 $50.67 -- -- 027 $53.22 027 $53.22 -- -- -- --
005 ALL RADIOLOGY 005 $3.82 -- -- 029 $4.00 029 $4.00 -- -- -- --
006 ALL PATHOLOGY 006 $0.76 -- -- 006 $0.76 006 $0.76 -- -- -- --
007 ALL MEDICINE 007 $0.82 017 $1.04 012 $1.07 023 $0.85 -- -- -- --
008 ALL REVIEW (MANUAL PRICING) 008 BY REPORT 008 BY REPORT 008 BY REPORT 008 BY REPORT 008 BY REPORT 008 BY REPORT
009 ALL FIXED PRICE 009 $1.00 009 $1.00 009 $1.00 009 $1.00 009 $1.00 009 $1.00
010 ALL PODIATRY RADIOLOGY -- -- -- -- -- -- -- -- 010 $3.82 -- --
014 ALL ABORTION 014 $34.46 -- -- 026 $36.19 026 $36.19 -- -- -- --
015 ALL PODIATRY SURGERY -- -- -- -- -- -- -- -- 015 $37.23 -- --
016 ALL GYN 016 $50.67 -- -- 027 $53.22 027 $53.22 -- -- -- --
017 ALL MEDICINE EMERGENCY -- -- 017 $1.04 -- -- -- -- -- -- -- --
019 ALL PODIATRY MEDICINE -- -- -- -- -- -- -- -- 019 $0.82 -- --
020 ALL ABORTION 020 $26.35 -- -- 021 $27.66 021 $27.66 -- -- -- --
030 ALL INJECTIONS 030 $4.46 -- -- 030 $4.46 030 $4.46 -- -- 030 $4.46
031 CHILD WELL CHILD EXAMS 031 $1.21 -- -- 032 $1.50 033 $1.28 -- -- -- --
034 ALL OB (VAGINAL DELIVERY) 034 $120.15 -- -- 034 $120.15 034 $120.15 -- -- -- --
035 ALL ABORTION 035 $37.23 -- -- 036 $39.10 036 $39.10 -- -- -- --
037 ALL ANESTHESIOLOGY (OB) 037 $17.06 -- -- 039 $17.92 039 $17.92 -- -- 038 $13.42
040 ALL OTHER OB 040 $50.67 -- -- 041 $53.22 041 $53.22 -- -- -- --
042 ALL SURGERY FIXED PRICE 042 $1.00 042 $1.00 042 $1.00 042 $1.00 042 $1.00 042 $1.00
052 ADULT PODIATRY PRIMARY CARE I & II - ADULT -- -- -- -- -- -- -- -- 052 $10.00 -- --
052 CHILD PODIATRY PRIMARY CARE I & II - CHILD -- -- -- -- -- -- -- -- 046 $10.91 -- --
053 ADULT PRIMARY CARE II - ADULT 053 $10.00 056 $12.42 050 $13.11 051 $10.44 -- -- -- --
053 CHILD PRIMARY CARE II - CHILD 049 $10.91 056 $12.42 047 $14.25 048 $11.36 -- -- -- --
054 ALL TUBAL STERILIZATIONS 054 $55.74 -- -- 055 $58.54 055 $58.54 -- -- -- --

The conversion indicators and conversion factors listed in the Rates worksheet are used in the Medi-Cal pricing system to calculate maximum reimbursement rates for physicians, non-physician medical practitioners, hospital outpatient departments and podiatrists (for example, conversion factor X unit value equals the maximum rate). The above chart can be used to calculate rates for other provider types (for example, clinics). To calculate a rate for another provider type, multiply the procedure unit value from the Rates worksheet by the provider-specific conversion factor listed above that cross-references to the Rates worksheet conversion indicator for that particular procedure. Note also that for primary care procedures, the correct conversion factor depends on the patient's age. An adult is over 17 years of age; a child is 17 years of age or under.


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