PARTNERTHIP HEALTHPLAN OF CALIFORNIA MEDI-CAL PROVIDER MANUAL CLAIMS DEPARTMENT
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1 Evaluation and Management (E&M) performed by a Non Physician Medical Practitioner (NMP) Office or Other Outpatient Services Hospital Inpatient Services , , 2384 SA, SB, U7, 24, 25, , , 24, , 239 Consolations , 25 Emergency , 25 Department Services Critical Care Services , 25 Nursing Facility , 25 Services (E&M) Domiciliary, Boarding Home or Custodial Care Services , 25 Home Services , 25 Preventive Medicine ,25 Services (E&M) Behavior Change 406, Intervention (E&M) Unlisted Preventive , 25 Medicine Service (E&M) Unlisted E&M Service 4 24, 25 Medicine performed by 90673, SA, BA, U7, 22, a NonPhysician Medical Practitioner (NMP) Vaccine for Vaccines for Children (VFC) 90633, , , 90660, 90680, 90685, 90686, 90688, 90700, 90707, 90710, , 90723, 90734, 90743,90744, SL Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 1
2 Vaccine for High Risk 90632, 90636, 90675, , 90704, 90717, 90725, 90727, Vaccine for High Risk and VFC 90620, 90621, 90630, SK SA, SB, SK, SL, UD, U7, SK, SL SL 90636, 90660, 90732, SK, SL Infusion Therapy 90780, , Unlisted Therapeutic 96372, SA, SB, 22, Prophylactic or Diagnostic Injections Psychiatry , 90870,90871 P1, ZE, ZF, ZG, 22, Dialysis , Gastroenterology , , , , 22, Ophthalmology 92002, 92004, 92012, , SA, SB, U7, 22, 24, 25, 22, P1, ZE, ZF, ZG, 22, 22, Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 2
3 Ophthalmology continued , SC, , LT, RT, 50 TC, ZS, 26, 92136, , LT, RT, 50 22, LT, RT, 50, 22, LT, RT, 50 22, 92235, LT, RT, , , , SC AP, Special Otorhinolaryngologic V2630V2632, , P1, ZA, ZE, ZF, ZG, 22, 22, Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 3
4 Special Otorhinolaryngologic Continued , TC, ZS, 26 22, 22, Cardiovascular , 92937, 92941, , 92938, , , 22,, 22,, 22,, 22,, 22,, ET, P1, P3, P4, P5, ZD, ZE, ZF, ZG, 22,,, 92986, 92987, 920 P1, ZE, ZF, ZG,, , , 76, 22, 22, 76, 22, Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 4
5 Cardiovascular Continued , , , 93280, 93282, 93283, 93285, 93288, 93289, , , 93315, , , 93462, , , 93561, ,, , 93602, 93603, , , ,, 93624, , 93644, ,, , Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 5
6 Cardiovascular Continued NonInvasive Vascular Diagnostic Studies Pulmonary , 22, 22, 94772, , Allergy and Clinical , Immunology Neurology , , U7 22, Chemotherapy , Administration Special Dermatologic Z0308, 22, Procedures Physical Medicine , Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 6
7 Special Services and Reports Z5424, Z5432, , Critical Care Neonatal Critical Care (ECMO/ECLS) 05 Years of Age 152 Z0100Z0108, , 33951, 339, 33955, 33957, 33959, 33963, 33965, 33969, 33985, Other Services Z0310, 1751 Evaluation and , Management Services , 2384 Miscellaneous , , S3620, S3626, Z , 22, AG, ET, PA, PB, PC, SA, SB, SC, UA, UB, U7, 22, 47, 50, 51,, 54, 55, 62, 63*, 66, 76, 77, 78, 79, 80, (Do not report Mod 63 with 33946, 33947, or 33939) 22, 22,, QW, ZS, 90, Some radiology/pathology codes may not require a modifier at all. See the Pathology and Radiology Sections in the appropriate Part 2 of the MediCal Manual for the MediCal policy regarding pathology and radiology codes. Modifiers P1, ZE or ZG may be used for anesthesia reimbursement when essential performance or radiology or pathology procedure. These are the only modifiers that can be used for the above listed HCPCS and CPT4 codes for MediCal. Updated 08/02/2017 PHC Medi-Cal Provider Manual Section 3, Subsection III.E.2 Page 7
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