DHCS begins retroactive reprocessing of two undervalued CPT codes

April 23, 2018
Area(s) of Interest: Advocacy Payor Issues and Reimbursement 

As previously reported, the California Department of Health Care Services (DHCS) began the retroactive rate adjustment to increase reimbursement levels for CPT codes 17110 and 17111 on April 12, 2018. Payment corrections for services dating back to January 1, 2017, will be reflected on participating physicians’ Remittance Advice Detail forms with no action required by impacted physicians.

These changes stem from concerns voiced by the California Medical Association (CMA) regarding DHCS’ pricing of the CPT code for destruction of up to 14 benign skin lesions (CPT 17110) at a higher level than it priced a more complex procedure for the destruction of 15 or more lesions (CPT 17111). CMA escalated the issue to DHCS, asking that it investigate the issue. After months of discussions with DHCS, it was announced in October that DHCS was increasing reimbursement on both codes, resulting in an increase of 19 percent on CPT 17110 and an increase of 71 percent on CPT 17111. DHCS began reimbursing at the higher rate on October 1, 2017.


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