CMA advocacy results in DHCS revaluing two CPT codes

March 22, 2018
Area(s) of Interest: Advocacy Payor Issues and Reimbursement 

The California Medical Association (CMA) received a call from a physician member with concerns that the California Department of Health Care Services (DHCS) had priced a 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 so it could investigate. Upon further inspection and months of discussions, DHCS announced in October that it 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

DHCS further agreed to make the change retroactive to January 1, 2017. It is scheduled to begin automatically reprocessing affected claims dating back to January 1, 2017, sometime this spring.

Physicians are encouraged to stay up to date on Medi-Cal changes and updates by signing up to receive Medi-Cal’s Subscription Services bulletin at http://files.medi-cal.ca.gov/pubsdoco/mcss/mcss.asp.


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