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UPDATE

May 23, 2014  

 

 

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

80048

80051

80053

81001

80069

80074

80178

81000

82010

81002

81003

81005

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

86618

85651

86294

86308

87077

87389

86701

86703

86803

87807

87808

87449

87621

87804

87900

  

87809

87880

87899

80061

  
  

 

  

California Society of Pathologists
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Tel : 916-446-6001
Fax :  916-444-7462