Erroneous Family PACT Denials for Same Day Billing of Evaluation and Management and Education and Counseling Codes

October 8, 2021

The February 2021 Family PACT Update notified providers of updates to Healthcare Common Procedure Coding System (HCPCS) codes for Quarter 1 of 2021. This update included several changes to Evaluation and Management (E&M) billing and coding, including allowing Education and Counseling (E&C) codes 99401 through 99403 with modifier U6 to be billed with E&M codes 99202 through 99204 and 99212 through 99214 on the same date of service.

The Department of Health Care Services (DHCS) is aware of claim denials occurring when providers attempt to bill an E&M code with an E&C code on the same date of service and is actively working on a solution. Further guidance will be provided in a future Family PACT Update.