Reminder to FQHC/RHC/IHS-MOA Providers of Upcoming Code Conversion

June 16, 2017

Effective for dates of service on or after October 1, 2017, claims billed with Healthcare Common Procedure Coding System (HCPCS) Level III local per-visit codes, except for local per-visit code 03 for dental services, will no longer be eligible for reimbursement and will be denied.

Claims submitted by Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC), and Indian Health Services-Memorandum of Agreement (IHS-MOA) providers without a valid code set for dates of service on or after October 1, 2017, will be denied. Providers have three options for countering a denied claim:

  • Submit a new claim with corrected information if the dates of service are within the six month billing limit;
  • Submit an appeal within 90 days of the date on a Remittance Advice Details (RAD) form showing the claim denial;
  • Submit a Claims Inquiry Form (CIF) within six months of the date on the RAD form showing the claim denial.

Providers may request additional onsite or telephone support via the Telephone Service Center (TSC) at 1-800-541-5555, from 8 a.m. to 5 p.m., Monday through Friday, except holidays. Providers calling from outside of California can contact TSC at 1-916-636-1200.

For additional information, providers may: