Additions and Exceptions

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 optional
• 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 Child Health and Disability Prevention (CHDP) program or family planning related
• Use A1 if services are CHDP-related
• 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 Child Health and Disability Prevention (CHDP) program or family planning related
• Use CPT codes and not ICD-10 codes in boxes 80 and 81