Correction: Code Conversion Technical Publications and Support Clarification
October 25, 2018
In October and November 2017, and July 2018, billing instructions were published regarding informational line billing for FQHC/RHC/IHS-MOA providers. This correction pertains to the information published in the Medi-Cal Computer Media Claim (CMC) Billing and Technical Manual, “Special Billing Instructions: FQHC/RHC/IHS-MOA,” HIPAA : FQHC/RHC/IHS-MOA Code Conversion FAQs, recorded webinars and provider training on the Medi-Cal Learning Portal (MLP) and Newsflashes.
The instructions when completing informational lines in the Service Units field (Box 46) and Total Charges field (Box 47) have changed. An informational line details the specific services provided during the global visit and is listed immediately following the HIPAA-compliant billing code set used to bill the face-to-face encounter with the recipient. Informational lines are not separately reimbursed.
The addition of CPT Category I or HCPCS Level II codes, which identify the actual services provided, should be included on the informational lines for dates of service on or after October 1, 2017. When submitting data for informational lines, providers should remember:
- The Revenue Code field (Box 42) on the informational line must be a four-digit revenue code. Reference ASC X12N 837 v.5010 Loop 2400 Segment SV201.
- Entering a service date in the Service Date field (Box 45) on the informational line is optional.
- The Service Units field (Box 46) on the informational line may contain the number of service units provided for the procedure code on paper claim forms (NUBC). For Electronic Data Interchange (EDI) transactions, reference ASC X12N 837 v.5010 Loop 2400 Segment SV205.
- The Total Charges field (Box 47) on paper claims for each informational line must be zeros. For EDI transactions, reference ASC X12N 837 v.5010 Loop 2400 Segment SV203.
- Modifiers should accompany procedure codes on informational lines, when applicable.
- CMCs submitted with an informational line on the first detail line of the claim will be rejected. CMC detail line 01 must include only HIPAA-compliant billing code sets.
- When billing electronic CMCs, if the addition of informational lines causes the claim to exceed 22 lines, the claim must be split with services billed on separate claims. Electronic claims that exceed 22 claim lines with informational lines will be denied in their entirety.
Updated manual pages reflecting this policy will be released in a future Medi-Cal Update