Home

Publications

Provider Manuals

Part 2 - Pharmacy

Medi-Cal Program (00medi-cal) (Revision Date Apr 16, 2021) |95KB)

How to Use This Manual (0B hw to use) (Revision Date Feb 16, 2022) |392KB)

Getting Started: Where to Find the Answers (0C get start) (Revision Date Jan 14, 2022) |269KB)

Appeal Form Completion (appeal form) (Revision Date Mar 16, 2023) |628KB)

California Children’s Services (CCS) Program (cal child) (Revision Date Dec 31, 2021) |166KB)

California Children’s Services (CCS) Program Approved Hospitals (cal child appr) (Revision Date Aug 14, 2020) |111KB)

California Children’s Services (CCS) Program Billing (cal child bil) (Revision Date Jun 16, 2022) |140KB)

California Children’s Services (CCS) Program Billing Example: CMS-1500 (cal child bil cms) (Revision Date Jun 16, 2022) |602KB)

CCS Program Billing Guidelines (cal child bil guide) (Revision Date Jun 16, 2022) |77KB)

California Children’s Services (CCS) Program County Office Directory (cal child county) (Revision Date Oct 15, 2021) |182KB)

California Children’s Services (CCS) Program Eligibility (cal child elig) (Revision Date Jun 16, 2022) |170KB)

California Children’s Services (CCS) Program Medical Therapy Program (cal child med) (Revision Date Nov 30, 2021) |158KB)

California Children’s Services (CCS) Program Provider Paneling (cal child panel) (Revision Date Nov 30, 2021) |207KB)

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Physicians and Podiatrists (DHS 4514) (Revision Date Mar 11, 2023) |45KB)

Form: California Children’s Services (CCS) Program Individual Provider Paneling Application for Allied Health Care Professionals (DHS 4515 ) (Revision Date Mar 11, 2023) |69KB)

California Children’s Services (CCS) Program Referrals (cal child ref) (Revision Date Jun 16, 2022) |147KB)

California Children’s Services (CCS) Program Service Authorization Request (SAR) (cal child sar) (Revision Date Apr 29, 2022) |227KB)

California Children’s Services (CCS) Program Service Code Groupings (cal child ser) (Revision Date Jan 13, 2023) |485KB)

California Children’s Services (CCS) Program Special Care Centers (cal child spec) (Revision Date Sep 16, 2020) |91KB)

CIF Completion (cif co) (Revision Date May 16, 2022) |710KB)

CIF Special Billing Instructions (cif sp) (Revision Date Dec 31, 2021) |623KB)

CIF Submission and Timeliness Instructions (cif sub) (Revision Date Mar 16, 2023) |172KB)

Clinical Trials Policy (clinic trial) (Revision Date Feb 16, 2023) |233KB)

CMS-1500 Completion (cms comp) (Revision Date Oct 14, 2022) |835KB)

CMS-1500 Special Billing Instructions (cms spec) (Revision Date Oct 16, 2020) |212KB)

CMS-1500 Submission and Timeliness Instructions (cms sub) (Revision Date Oct 14, 2022) |130KB)

CMS-1500 Tips for Billing (cms tips) (Revision Date Oct 16, 2020) |165KB)

Durable Medical Equipment (DME): An Overview (dura) (Revision Date Mar 16, 2023) |151KB)

Form: Certificate of Medical Necessity for All Durable Medical Equipment (DME) (Except Wheelchairs and Scooters) (DHS 6181) (Revision Date May 29, 2020) |127KB)

Form: Certificate of Medical Necessity for Apnea Monitors (MC 4600) (Revision Date Mar 14, 2023) |41KB)

Form: Certificate of Medical Necessity for Nebulizers (MC 4601) (Revision Date Mar 14, 2023) |37KB)

Form: Certificate of Medical Necessity for Oxygen (MC 4602) (Revision Date Mar 10, 2023) |56KB)

Durable Medical Equipment (DME): Bill for DME (dura bil) (Revision Date Mar 16, 2023) |212KB)

Durable Medical Equipment (DME): Bill for Wheelchairs and Wheelchair Accessories (dura bil wheel) (Revision Date Mar 16, 2023) |202KB)

Form: Certificate of Medical Necessity for a Manual Wheelchair, Standard or Custom (DHS 6181-A) (Revision Date May 29, 2020) |474KB)

Form: Certificate of Medical Necessity for a Motorized Wheelchair, Custom or Standard (DHS 6181-B) (Revision Date May 29, 2020) |447KB)

Form: Certificate of Medical Necessity for a Power Operated Vehicle (POV) aka Scooter, Standard or Bariatric (DHS 6181-C) (Revision Date May 29, 2020) |390KB)

Durable Medical Equipment (DME): Billing Codes (dura cd) (Revision Date Mar 17, 2023) |1057KB)

Durable Medical Equipment (DME): Billing Codes for California Children’s Services (CCS) (dura cd ccs) (Revision Date Nov 30, 2021) |116KB)

Durable Medical Equipment (DME) Billing Codes: Frequency Limits (dura cd fre) (Revision Date Mar 16, 2023) |277KB)

Durable Medical Equipment (DME): Billing Examples (dura ex) (Revision Date Sep 16, 2020) |4011KB)

Durable Medical Equipment (DME): Infusion Equipment (dura inf) (Revision Date Mar 16, 2023) |139KB)

Durable Medical Equipment (DME): Other DME Equipment (dura other) (Revision Date Mar 16, 2023) |321KB)

Durable Medical Equipment (DME): Oxygen and Respiratory Equipment (dura oxy) (Revision Date Mar 16, 2023) |453KB)

Durable Medical Equipment (DME): Therapeutic Anti-Decubitus Mattresses and Bed Products (dura thp) (Revision Date Mar 16, 2023) |373KB)

Durable Medical Equipment (DME): Wheelchair and Wheelchair Accessories Guidelines (dura wheel guide) (Revision Date Jul 16, 2021) |273KB)

End of Life Option Act Services (eloa) (Revision Date Dec 16, 2022) |254KB)

End of Life Option Act Services Billing Examples: CMS-1500 (eloa cms) (Revision Date Dec 16, 2022) |590KB)

Enteral Nutrition Products (enteral) (Revision Date Mar 16, 2023) |89KB)

EPSDT (epsdt) (Revision Date Nov 16, 2022) |144KB)

Forms: Legibility and Completion Standards (forms leg) (Revision Date Oct 16, 2020) |129KB)

Forms Reorder Request: Guidelines (forms reo) (Revision Date Dec 31, 2021) |107KB)

Forms Reorder Request: Pharmacy (forms reo ph) (Revision Date Dec 31, 2021) |152KB)

Genetically Handicapped Persons Program (GHPP) (genetic) (Revision Date Dec 31, 2021) |246KB)

Immunizations (immun) (Revision Date Mar 16, 2023) |554KB)

Immunizations Code List (immun cd) (Revision Date Mar 16, 2023) |136KB)

Incontinence Medical Supplies (incont) (Revision Date Apr 29, 2022) |229KB)

Incontinence Medical Supplies Example: CMS-1500 (incont ex) (Revision Date Apr 29, 2022) |501KB)

Injections: An Overview (inject an over) (Revision Date Dec 16, 2022) |167KB)

Injections: Code List (inject cd list) (Revision Date Mar 16, 2023) |452KB)

Injections: Drugs A-D Policy (inject drug a-d) (Revision Date Mar 16, 2023) |585KB)

Injections: Drugs E-H Policy (inject drug e-h) (Revision Date Feb 16, 2023) |629KB)

Injections: Drugs I-M Policy (inject drug i-m) (Revision Date Mar 16, 2023) |418KB)

Injections: Drugs N-R Policy (inject drug n-r) (Revision Date Feb 16, 2023) |427KB)

Injections: Drugs S-Z Policy (inject drug s-z) (Revision Date Mar 16, 2023) |360KB)

Injections: Hydration (inject hydra) (Revision Date Aug 31, 2020) |118KB)

Intravenous or Intra-arterial Solutions: Administration Sets (iv sol admin) (Revision Date Aug 31, 2020) |108KB)

Intravenous or Intra-arterial Solutions: Special Billing (iv sol spec) (Revision Date Dec 31, 2021) |121KB)

Medical Supplies (mc sup) (Revision Date Mar 16, 2023) |259KB)

Medical Supplies: Billing Examples (mc sup ex) (Revision Date Jul 30, 2021) |719KB)

Medicare/Medi-Cal Crossover Claims: CMS-1500 Billing Examples for Pharmacy (medi cr cms exp) (Revision Date Dec 31, 2021) |492KB)

Medicare/Medi-Cal Crossover Claims: CMS-1500 Pricing Examples for Pharmacy (medi cr cms prp) (Revision Date Dec 31, 2021) |450KB)

Medicare Non-Covered Services: HCPCS Codes (medi non hcp) (Revision Date Mar 16, 2023) |126KB)

Medication Therapy Management (mtm serv) (Revision Date Oct 14, 2022) |208KB)

Orthotic and Prosthetic Appliances and Services (ortho) (Revision Date Nov 16, 2022) |188KB)

Form: Physician Certification of Medical Necessity for Therapeutic Diabetic Shoes and Inserts (ortho 1 form) (Revision Date Aug 31, 2020) |68KB)

Orthotic and Prosthetic Appliances and Services: Criteria for Authorization and Reimbursement – Orthotics (ortho auth ortho) (Revision Date Nov 16, 2022) |336KB)

Orthotic and Prosthetic Appliances and Services: Criteria for Authorization and Reimbursement – Prosthetics (ortho auth pros) (Revision Date Nov 16, 2022) |268KB)

Orthotic and Prosthetic Appliances: Billing Codes – Orthotics (ortho cd1) (Revision Date Nov 16, 2022) |367KB)

Orthotic and Prosthetic Appliances: Billing Codes – Prosthetics (ortho cd2) (Revision Date Nov 16, 2022) |281KB)

Orthotics and Prosthetics: Frequency Limits for Orthotics (ortho cd fre1) (Revision Date Nov 16, 2022) |266KB)

Orthotics and Prosthetics: Frequency Limits for Prosthetics (ortho cd fre2) (Revision Date Nov 16, 2022) |249KB)

Orthotic and Prosthetic Appliances: Biling Examples (ortho ex) (Revision Date May 16, 2022) |1288KB)

Other Health Coverage (OHC) (oth hlth) (Revision Date Feb 16, 2023) |83KB)

Pharmacist Services (pharm serv) (Revision Date Mar 16, 2022) |231KB)

Physician-Administered Drugs (physician) (Revision Date Dec 31, 2021) |148KB)

Physician-Administered Drugs – NDC (physician ndc) (Revision Date Dec 31, 2021) |150KB)

Physician-Administered Drugs – NDC: CMS-1500 Billing Instructions (physician ndc cms) (Revision Date Dec 31, 2021) |204KB)

Presumptive Eligibility for Pregnant Women (presum) (Revision Date May 16, 2022) |159KB)

Presumptive Eligibility for Pregnant Women: Billing Codes (presum bill) (Revision Date Feb 16, 2023) |314KB)

Presumptive Eligibility for Pregnant Women Program Process (presum proc) (Revision Date Mar 16, 2023) |140KB)

Presumptive Eligibility for Pregnant Women Provider Enrollment Instructions (presum prov) (Revision Date Aug 31, 2020) |130KB)

Form: Presumptive Eligibility for Pregnant Women Provider Enrollment Checklist (presum prov enroll frm) (Revision Date Mar 16, 2023) |70KB)

Provider Billing after Beneficiary Reimbursement (Conlan v. Shewry) (prov bil) (Revision Date Dec 31, 2021) |127KB)

Reimbursement (reimbursement) (Revision Date Dec 31, 2021) |201KB)

Remittance Advice Details (RAD) (remit adv) (Revision Date Mar 16, 2023) |123KB)

Remittance Advice Details (RAD) Examples: Allied Health, Medical Services and Pharmacy (remit ex amp) (Revision Date Jan 14, 2022) |294KB)

Remittance Advice Details (RAD): Payments and Claim Status (remit pay) (Revision Date May 16, 2022) |75KB)

Share of Cost (SOC): CMS-1500 (share cms) (Revision Date Dec 31, 2021) |823KB)

Sign Language Interpretation (sign) (Revision Date Aug 31, 2020) |136KB)

Subacute Care Programs: Adult (subacut adu) (Revision Date Aug 31, 2020) |134KB)

Subacute Care Programs: Level of Care for Adults and Children (subacut lev) (Revision Date Dec 16, 2022) |156KB)

Form: Information for Authorization/Reauthorization of Subacute Care Services – Adult Subacute Program (DHS 6200 A) (Revision Date May 29, 2020) |121KB)

Subacute Care Programs: Pediatric (subacut ped) (Revision Date Aug 31, 2020) |136KB)

TAR Completion (tar comp) (Revision Date Jun 16, 2022) |398KB)

TAR Deferral/Denial Policy (Frank v. Kizer) (tar defer) (Revision Date Dec 31, 2021) |1563KB)

TAR Field Office Addresses (tar field) (Revision Date Dec 31, 2021) |357KB)

TAR Submission: Transmittal Form (tar submis) (Revision Date Aug 31, 2020) |220KB)

TAR: Submitting Appeals (tar submit) (Revision Date Sep 28, 2020) |114KB)

Taxable and Non-Taxable Items (tax) (Revision Date Jul 15, 2022) |697KB)

Note:

Download PDF (Portable Document Format) reader from the Web Tool Box.