Medi-Cal Bulletin Announces Change in Split Billing
for Some CP Codes
The article and link pasted below are contained in the May Medi-Cal General Medicine Bulletin. It indicates that effective July 1, 2014 these 88 clinical pathology codes are not eligible for split billing. This would eliminate the ability of hospital based pathologists to bill these codes on a PC only basis. The CSP has reached out to DHCS and will strongly oppose this change. It is inconsistent with the new DRG type payment system that Medi-Cal uses to reimburse hospitals that specifically excludes the professional component of AP and CP from the DRG type payment. We will keep you informed.
Click here for a link to the article.
Text from the article:
3. Looking Ahead: Discontinued Split Billing for Select Lab Codes
Effective for dates of service on or after July 1, 2014, the following CPT-4 codes will no longer be split billable using modifiers 26, TC or ZS. The change in billing status is the result of Medi-Cal aligning split-bill percentages with the Centers for Medicare & Medicaid Services split-bill percentages. Manual pages reflecting these changes will be released in a future Medi-Cal Update. When available, the split-bill percentages will be posted on the Medi-Cal Rates page of the Medi-Cal website.
The following procedure codes, found in several pathology-related sections of the Medi-Cal provider manual, represent only a small fraction of affected codes with split-bill percentages that will be changing. However, these are the codes for which split billing will no longer be an option.
CPT-4 Procedure Codes No Longer Split-Billable, Effective July 1, 2014
80047
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80048
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80051
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80053
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81001
|
80069
|
80074
|
80178
|
81000
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82010
|
81002
|
81003
|
81005
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81015
|
82150
|
82040
|
82043
|
82055
|
82120
|
82274
|
82247
|
82270
|
82271
|
82272
|
82465
|
82310
|
82330
|
82374
|
82435
|
82679
|
82523
|
82550
|
82565
|
82570
|
82962
|
82947
|
82950
|
82951
|
82952
|
83026
|
82977
|
82985
|
83001
|
83002
|
83721
|
83036
|
83605
|
83655
|
83718
|
84132
|
83861
|
83880
|
83986
|
84075
|
84460
|
84155
|
84295
|
84443
|
84450
|
84830
|
84478
|
84520
|
84550
|
84703
|
85610
|
85013
|
85014
|
85018
|
86318
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86618
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85651
|
86294
|
86308
|
87077
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87389
|
86701
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86703
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86803
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87807
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87808
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87449
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87621
|
87804
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87900
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87809
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87880
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87899
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80061
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California Society of Pathologists
One Capitol Mall Suite 320
Sacramento, CA 95814 Tel : 916-446-6001
Fax : 916-444-7462
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