Medi-Cal Rates as of 07/15/2021
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
Important Payment Information
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® 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.
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 UA and UB Modifier Maximum Allowable Reimbursement Rates for Surgical and Anesthesia Supplies and Drugs
The rate tables linked below contain lists of reimbursement rates by procedure code that have been adjusted in accordance with a State Plan Amendment. This table is for informational purposes only and may not reflect current reimbursement rates. For current rates, use the links above to access the current Medi-Cal rate table.
- Clinical Laboratory Rates effective January 1, 2020, updated in accordance with State Plan Amendment 20-0003
- Clinical Lab Report Rates effective July 1, 2020, updated in accordance with State Plan Amendment 20-0010
- COVID-19 Clinical Lab Rates for Medi-Cal Children in Schools effective February 1, 2021, updated in accordance with State Plan Amendment 20-0046
- Durable Medical Equipment Oxygen and Respiratory Temporary COVID-19 Rate Updates, effective March 1, 2020 and January 1, 2021, as applicable.
- Radiology Rates, effective January 1, 2019, updated in accordance with State Plan Amendment 19-0003.
- Radiology Rates, effective January 1, 2020, updated in accordance with State Plan Amendment 20-0004.
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