Part 2 - Pharmacy



Appeal Form Completion (appeal form) (Revision Date May 29, 2020) | (792KB)
Blood and Blood Derivatives (blood) (Revision Date Jun 30, 2020) | (192KB)
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)
Compound Pharmacy Claim Form (30-4) Examples (compound ex) (Revision Date May 29, 2020) | (665KB)
Drug Use Review (DUR) Program (drug) (Revision Date May 29, 2020) | (136KB)
Drugs: Contract Drugs List Introduction (drugs cdl intr) (Revision Date May 29, 2020) | (25KB)
Drugs: MAIC Rate Review (drugs maic rate) (Revision Date May 29, 2020) | (76KB)
Durable Medical Equipment (DME): An Overview (dura) (Revision Date May 29, 2020) | (142KB)
Durable Medical Equipment (DME): Bill for DME (dura bil) (Revision Date May 29, 2020) | (233KB)
Durable Medical Equipment (DME): Billing Examples (dura ex) (Revision Date May 29, 2020) | (3295KB)
End of Life Option Act Services (eloa) (Revision Date May 29, 2020) | (216KB)
Enteral Nutrition Products (enteral) (Revision Date May 29, 2020) | (200KB)
EPSDT (epsdt) (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)
Forms Reorder Request: Pharmacy (forms reo ph) (Revision Date May 29, 2020) | (404KB)
Genetically Handicapped Persons Program (GHPP) (genetic) (Revision Date May 29, 2020) | (225KB)
Immunizations (immun) (Revision Date Jun 16, 2020) | (214KB)
Immunizations Code List (immun cd) (Revision Date Jun 16, 2020) | (69KB)
Incontinence Medical Supplies (incont) (Revision Date May 29, 2020) | (170KB)
Injections: An Overview (inject an over) (Revision Date May 29, 2020) | (127KB)
Injections: Code List (inject cd list) (Revision Date Jun 16, 2020) | (262KB)
Injections: Drugs A-D Policy (inject drug a-d) (Revision Date Jun 16, 2020) | (386KB)
Injections: Drugs E-H Policy (inject drug e-h) (Revision Date Jul 16, 2020) | (397KB)
Injections: Drugs I-M Policy (inject drug i-m) (Revision Date Jul 16, 2020) | (296KB)
Injections: Drugs N-R Policy (inject drug n-r) (Revision Date May 29, 2020) | (278KB)
Injections: Drugs S-Z Policy (inject drug s-z) (Revision Date Jun 16, 2020) | (270KB)
Injections: Hydration (inject hydra) (Revision Date May 29, 2020) | (109KB)
Medical Supplies (mc sup) (Revision Date May 29, 2020) | (187KB)
Medical Supplies: Billing Examples (mc sup ex) (Revision Date May 29, 2020) | (1342KB)
Medicare-Covered Drugs (medicare drugs) (Revision Date May 29, 2020) | (53KB)
Medicare Non-Covered Services: HCPCS Codes (medi non hcp) (Revision Date May 29, 2020) | (87KB)
Orthotic and Prosthtic Appliances and Services (ortho) (Revision Date Jun 16, 2020) | (231KB)
Other Health Coverage (OHC) (oth hlth) (Revision Date May 29, 2020) | (137KB)
Pharmacy Claim Form (30-1) Completion (pcf30-1 comp) (Revision Date Jun 16, 2020) | (565KB)
Pharmacy Claim Form (30-1) Examples (pcf30-1 ex) (Revision Date May 29, 2020) | (1023KB)
Pharmacy Claim Form (30-1) Tips for Billing (pcf30-1 tips) (Revision Date May 29, 2020) | (103KB)
Pharmacist Services (pharm serv) (Revision Date May 29, 2020) | (222KB)
Physician-Administered Drugs (physician) (Revision Date May 29, 2020) | (108KB)
Presumptive Eligibility for Pregnant Women (presum) (Revision Date May 29, 2020) | (95KB)
Reimbursement (reimbursement) (Revision Date May 29, 2020) | (211KB)
Remittance Advice Details (RAD) (remit adv) (Revision Date May 29, 2020) | (141KB)
Share of Cost (SOC): 30-1 for Pharmacy (share ph) (Revision Date May 29, 2020) | (747KB)
Sign Language Interpretation (sign) (Revision Date May 29, 2020) | (200KB)
Subacute Care Programs: Adult (subacut adu) (Revision Date May 29, 2020) | (106KB)
Subacute Care Programs: Pediatric (subacut ped) (Revision Date May 29, 2020) | (114KB)
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: Drug TARs (tar sub drug) (Revision Date May 29, 2020) | (136KB)
TAR Submission: Transmittal Form (tar submis) (Revision Date May 29, 2020) | (258KB)
TAR: Submitting Appeals (tar submit) (Revision Date May 29, 2020) | (86KB)
Taxable and Non-Taxable Items (tax) (Revision Date May 29, 2020) | (329KB)


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