Updated Every Woman Counts Covered Procedure Forms

Effective for dates of service on June 1, 2020, the following Every Woman Counts Covered Procedure forms are being replaced on the Medi-Cal website.

• Every Woman Counts Program BREAST ONLY Primary Care Provider Covered Procedures (DHCS 8471)


• Every Woman Counts Program BREAST and CERVICAL Primary Care Provider Covered Procedures (DHCS 8472)


• Every Woman Counts Program REFERRAL PROVIDERS Primary Care Provider Covered Procedures (DHCS 8473)