X

CMA updates Prop 56 Payment Monitoring Worksheet

August 19, 2019
Area(s) of Interest: Practice Management 


The California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Prop. 56) created new revenues dedicated to the Medi-Cal program. Physicians receive supplemental payments in both fee-for-service and Medi-Cal managed care when providing Medi-Cal services under certain CPT codes. The supplemental payments increase payments on 23 CPT codes for FY 18-19, including 10 new preventive codes. A full list of the eligible CPT codes is listed below. 

To help physician practices monitor their Prop 56 supplemental payments, the California Medical Association (CMA) has published a Prop. 56 Payment Monitoring Worksheet. The worksheet has been updated to help physicians determine if they have been paid correctly based on the FY 18-19 supplemental payment amounts.

The worksheet will automatically calculate the supplemental payment amount due by CPT code so you can ensure that you are receiving your share of the supplemental tobacco tax money.

The worksheet is available free to CMA members at cmadocs.org/prop56.

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 $74.43 $181.43 144%
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 $20.60 $25.60 24%
99381 Prev. Visit Est. Pt Ages < 1 year $40.80 $117.80 189%
99382 Prev. Visit Est. Pt Ages 1-4 Years $42.42 $122.42 189%
99383 Prev. Visit Est. Pt Ages 5-11 Years $49.35 $126.35 156%
99384 Prev. Visit Est. Pt Ages 12-17 Years $59.20 $142.20 140%
99385 Prev. Visit Est. Pt Ages 18-39 Years $102.69 $132.69 29%
99391 Prev. Visit New Pt Ages < 1 Year $31.22 $106.22 240%
99392 Prev. Visit New Pt Ages 1-4 Years $33.65 $112.65 235%
99393 Prev. Visit New Pt Ages 5-11 Years $39.47 $111.47 182%
99394 Prev. Visit New Pt Ages 12-17 Years $49.35 $121.35 146%
99395 Prev. Visit New Pt Ages 18-39 Years $92.61 $119.61 29%

Stay Informed

Opt in to receive updates on the latest health care news, legislation, and more.

Join CMA Today!

Explore why over 44,000 California physicians have joined CMA to advocate for patients, the medical profession and the future of health care.

Was this page helpful?