Additions and Exceptions
Provider Type
- Hospitals
Outpatient Claims
The following are additions or exceptions to commercial billing rules. Facilities are required to follow these guidelines for Medi-Cal billing:
- Bill type is desired (a delay in claims payment will result if not provided)
- Revenue codes are required
- CPT and HCPCS codes are required
- Place of Service code (box 50 on the UB-04 form) is required if the bill type field is left blank
- Complete condition code if services are preventive, well-child screening services or family planning related
- Use A1 if services are preventive, well-child screening services
- Use A3 if services are family planning-sterilization related
- Use A4 if services are family planning-other related
Inpatient Claims
The following are additions or exceptions to commercial billing rules. Facilities are required to follow these guidelines for Medi-Cal billing:
- Revenue code is required
- Bill type is required
- Place of Service code (box 50) is required if the bill type field is left blank
- Type of Admission code (box 19) is required
- Source of Admission code (box 20) is required
- Complete condition code field if services are preventive, well-child screening or family planning related
- Use CPT codes and not ICD-10 codes in boxes 80 and 81