Child Health and Disability Prevention code and claim form conversion effective July 1

June 21, 2017
Area(s) of Interest: HIPAA Licensing & Regulatory Issues 

The California Department of Health Care Services (DHCS) is currently transitioning Child Health and Disability Prevention (CHDP) program billing processes to be compliant with HIPAA standards for national health care electronic transactions and code sets. Rather than billing on the CHDP Confidential Screening/Billing Report (PM 160) claim form, claims will be submitted using CPT codes on the CMS 1500 or UB-04 claim forms or equivalent electronic claim transactions.

The transition, effective for dates of service on or after July 1, 2017, affects claims for Medi-Cal Early and Periodic Screening, Diagnosis and Treatment, well-child health assessments and immunizations through the CHDP program. After July 1, these services will also be billed as Medi-Cal services in accordance with Medi-Cal policy, will be reimbursed per the Medi-Cal fee-for-service fee schedule and will receive payment on the standard Medi-Cal warrant. DHCS has released an updated CHDP Code Conversion Table, which is accessible on its website.

Services provided prior to July 1, 2017, should be billed on the CHDP PM 160 claim form.

The California Medical Association (CMA) has received calls from physicians who report that for their practice, the transition to reimbursement based on the Medi-Cal fee-for-service schedule may result in a decrease of up to 20 percent for some services. CMA has also received questions about whether problem-focused evaluation and management visits, when billed with a preventive medicine visit, will continue to both be reimbursed as they were under the CHDP program. CMA has reached out to DHCS for clarification.

For more information, view June 2017 DHCS NewsFlash update.


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