X

DHCS receives approval on Medi-Cal supplemental tobacco tax payments for FY 2018-2019



September 20, 2018
Area(s) of Interest: Payor Issues and Reimbursement Advocacy Practice Management 

The California Department of Health Care Services (DHCS) recently received federal approval on its plan to increase Medi-Cal fee-for-service physician payments for the 2018-2019 fiscal year. The supplemental payments—made possible by the Proposition 56 tobacco tax funding—will raise payments for a total of 23 CPT codes, including 10 new preventive CPT codes.

DHCS will be increasing the supplemental payment for the previously eligible CPT codes to 85 percent of Medicare (a 40 percent average increase in payments for these eligible codes compared with 2017 – 2018 payment levels). The 10 newly added preventive CPT codes will be paid at 100 percent of Medicare.

According to DHCS, the prospective fee-for-service supplemental payments are anticipated to begin as soon as September 24. The timeline for the retroactive payments back to the beginning of the fiscal year (which began July 1, 2018) is still being worked out, but DHCS expects to distribute retroactive payments in early 2019.

There is no additional action required by providers to receive the supplemental payments. Reimbursement on claims for eligible codes (see table below) will automatically include the supplemental payments.

The supplemental payments would apply to both fee-for-service and managed care delivery systems, however approval for DHCS’s managed care proposal is still pending. In the interim, DHCS is continuing to distribute supplemental payments at the 2017-2018 amounts and eligible CPT codes to the Medi-Cal managed care plans with the expectation that those funds be paid to physicians within 90 days of receipt from DHCS. A full list of the eligible CPT codes is listed below.

 

CPT Code Description *2016 FFS
Base Rate
2018 Base Rate
w/ Prop 56
Supp Funds
% Increase
99211 Level 1 Est. Pt Visit $10.80 $20.80 93%
99212 Level 2 Est. Pt Visit $16.29 $39.29 141%
99213 Level 3 Est. Pt Visit $21.60 $65.60 204%
99214 Level 4 Est. Pt Visit $33.75 $95.75 184%
99215 Level 5 Est. Pt Visit $51.48 $127.48 148%
99201 Level 1 New Pt Visit $20.61 $38.61 87%
99202 Level 2 New Pt Visit $30.87 $65.87 113%
99203 Level 3 New Pt Visit $51.48 $94.48 84%
99204 Level 4 New Pt Visit $62.01 $145.01 134%
99205 Level 5 New Pt Visit $94.43 $181.43 92%
90791 Psych diagnostic eval $115.27 $150.27 30%
90792 Psych diagnostic eval w/ medical svcs $92.93 $127.93 38%
90863 Other psych services - pharmacologic mgmt $20.30 $25.60 26%
99381 Prev. Visit Est. Pt Ages < 1 year $45.33 $122.33 170%
99382 Prev. Visit Est. Pt Ages 1-4 Years $47.13 $127.13 170%
99383 Prev. Visit Est. Pt Ages 5-11 Years $54.83 $131.83 140%
99384 Prev. Visit Est. Pt Ages 12-17 Years $65.78 $148.78 126%
99385 Prev. Visit Est. Pt Ages 18-39 Years $114.10 $144.10 26%
99391 Prev. Visit New Pt Ages < 1 Year $34.69 $109.69 216%
99392 Prev. Visit New Pt Ages 1-4 Years $37.39 $116.39 211%
99393 Prev. Visit New Pt Ages 5-11 Years $43.85 $115.85 164%
99394 Prev. Visit New Pt Ages 12-17 Years $54.83 $126.83 131%
99395 Prev. Visit New Pt Ages 18-39 Years $102.90 $129.90 26%

Join CMA Today!

Explore why over 43,000 California physicians have joined CMA to advocate for patients, the medical profession and the future of health care.

Was this page helpful?