COVID-19 Testing: Billing Update for Medi-Cal COVID-19 Testing in Schools

March 25, 2021

Effective for dates of service on or after February 1, 2021, students in transitional kindergarten through the 12th grade, who are Medi-Cal beneficiaries, are eligible to receive coronavirus disease (COVID-19) clinical laboratory testing services, not including specimen collection services. These services are billable by eligible Medi-Cal providers when the service is provided in schools to students enrolled in Medi-Cal and in transitional kindergarten through the 12th grade.

When submitting a claim, eligible clinical laboratories and other eligible providers are required to indicate the location of the service for students enrolled in either Medi-Cal Fee-for-Service (FFS) or managed care. Place of Service (POS) Code 03 is for schools. All COVID-19 testing services, when provided in a school and billed with POS Code 03, will be carved out from being a managed care benefit and will be reimbursed through the FFS delivery system. Providers are reminded to utilize the Medi-Cal Benefits Identification Card (BIC) number when submitting claims to the FFS claims processing system for students in the managed care delivery system. All existing allowable provider types for the COVID-19 test codes today will be eligible to bill for the tests provided in schools.

When the service is provided in a school, Medi-Cal will reimburse for the COVID-19 testing services at 100 percent of the corresponding Medicare rate for the same or similar service, in accordance with State Plan Amendment (SPA) 20-0024. These services, when provided in a school, will also be exempt from the ten percent payment reductions under Assembly Bill (AB) 97 (2011) and as codified in Welfare and Institutions Code (W&I Code) Section 14105.192.

Upon expiration of the public health emergency or national emergency, whichever occurs first, the COVID-19 testing reimbursement rates will be amended to correspond with the clinical laboratory services methodology in W&I Code Section 14105.22, including the application of the AB 97 payment reduction.

The provider billing guidance for COVID-19 testing services for POS Code 03 was published prior to implementation of the system changes necessary to support appropriate adjudication. Therefore, providers who submitted claims for these services were denied erroneously with Remittance Advice Details Code 0037 (Health Care Plan/Mental Health Care enrollee, capitated service not billable to Medi-Cal). An Erroneous Payment Correction will be installed to reprocess these erroneously denied claims since the necessary system changes have been installed.

As system changes have been made, providers may elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

The updated manual pages reflecting this change will be released in a future Medi-Cal Update.