Non-Split-Billable Radiology and Laboratory Claims Erroneously Denied

December 13, 2019

The Department of Health Care Services (DHCS) has identified a claims processing issue affecting claims for non-split-billable radiology and laboratory services. This issue is causing claims to erroneously deny with Remittance Advice Details (RAD) code 0090: The combination of procedure code and modifier is not valid on the dates of service billed. The issue affects claims that were denied on or after mid-July 2019.

DHCS and the California Medicaid Management Information System (MMIS) Fiscal Intermediary (FI) are working to resolve this issue. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates.