Part 2 - Medical Transportation (MTR)



Appeal Form Completion (appeal form) (Revision Date May 29, 2020) | (792KB)
California Children's Services (CCS) Program (cal child) (Revision Date May 29, 2020) | (298KB)
CCS Program Billing Guidelines (cal child bil guide) (Revision Date May 29, 2020) | (68KB)
CIF Completion (cif co) (Revision Date May 29, 2020) | (813KB)
CIF Special Billing Instructions (cif sp) (Revision Date May 29, 2020) | (584KB)
CIF Submission and Timeliness Instructions (cif sub) (Revision Date May 29, 2020) | (138KB)
CMS-1500 Completion (cms comp) (Revision Date May 29, 2020) | (771KB)
CMS-1500 Special Billing Instructions (cms spec) (Revision Date May 29, 2020) | (234KB)
CMS-1500 Submission and Timeliness Instructions (cms sub) (Revision Date May 29, 2020) | (114KB)
CMS-1500 Tips for Billing (cms tips) (Revision Date May 29, 2020) | (140KB)
Contracted Inpatient Services for Allied Health (cont ah) (Revision Date May 29, 2020) | (153KB)
Forms: Legibility and Completion Standards (forms leg) (Revision Date May 29, 2020) | (99KB)
Forms Reorder Request: Guidelines (forms reo) (Revision Date May 29, 2020) | (86KB)
Genetically Handicapped Persons Program (GHPP) (genetic) (Revision Date May 29, 2020) | (225KB)
HCPCS Introduction (hcpcs) (Revision Date May 29, 2020) | (79KB)
Medical Transportation – Air (mc tran air) (Revision Date May 29, 2020) | (247KB)
Medical Transportation – Ground (mc tran gnd) (Revision Date Jul 16, 2020) | (222KB)
Medicare/Medi-Cal Crossover Claims: CMS-1500 (medi cr cms) (Revision Date May 29, 2020) | (220KB)
Medicare/Medi-Cal Crossover Claims: UB-04 (medi cr ub) (Revision Date May 29, 2020) | (233KB)
Medicare Non-Covered Services: HCPCS Codes (medi non hcp) (Revision Date May 29, 2020) | (87KB)
Modifiers: Approved List (modif app) (Revision Date Jul 16, 2020) | (295KB)
Other Health Coverage (OHC) (oth hlth) (Revision Date May 29, 2020) | (137KB)
Remittance Advice Details (RAD) (remit adv) (Revision Date May 29, 2020) | (141KB)
Share of Cost (SOC): CMS-1500 (share cms) (Revision Date May 29, 2020) | (586KB)
Sign Language Interpretation (sign) (Revision Date May 29, 2020) | (200KB)
TAR Completion (tar comp) (Revision Date May 29, 2020) | (288KB)
TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer) (Revision Date May 29, 2020) | (479KB)
TAR Field Office Addresses (tar field) (Revision Date May 29, 2020) | (260KB)
TAR Submission: Transmittal Form (tar submis) (Revision Date May 29, 2020) | (258KB)
TAR: Submitting Appeals (tar submit) (Revision Date May 29, 2020) | (86KB)


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