Updated March 3, 2009

Effective for dates of service on or after March 1, 2009, Medi-Cal payments to providers (unless exempted) will be subject to a 1% or 5% reduction, based on provider type. Welfare and Institutions Code (W&I) Section 14105.191 mandates the application of the 1% and 5% reduction with certain exceptions as noted therein. On February 27, 2009, the U.S. District Court issued a preliminary injunction instructing the Department of Health Care Services not to implement the 5 % payment reduction mandated by W&I Section 14105.191, as modified by AB 1183 (2008), to pharmacies for prescriptions drugs (including prescription drugs and traditional over-the-counter drugs provided by prescription) provided under the Medi-Cal fee-for-service program. For additional information on the payment reduction and the impact of the injunction, please refer to the Newsroom articles posted on the Medi-Cal home page.

The reimbursement rates published on this Website do not reflect the following payment augmentations or reductions that are applied as part of the final payment to Medi-Cal providers:

• 1% or 5% payment reductions as specified above
• 43.44% payment augmentation for services provided in a hospital outpatient department
• 39.7% payment augmentation for specified physicians’ services provided to California Children’s Services clients

This rates information is an extract of pricing data from the automated Medi-Cal pricing system as of the specific date shown. It lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT-4 coding system. Although every attempt will be made to keep this information up-to-date, it does not reflect changes made subsequent to the date of the extract.

• Download All Medi-Cal Rates
• View Medi-Cal Rates By Procedure Code

The rate table below contains reimbursement rates that were in effect on June 30, 2001. This table is provided as information only for provider reference, and does not reflect current reimbursement rates. For current rates, click the link above to access the current rate table.

• Medi-Cal Rates as of June 30, 2001

Medi-Cal UA and UB Modifier Maximum Allowable Reimbursement Rates for Surgical and Anesthesia Supplies and Drugs

• Medi-Cal UA and UB Modifier Rates for Surgical and Anesthesia Supplies and Drugs as of April 2013