Service Authorization Request (SAR) Tools

Dental Crosswalk - CDT-4 Codes

Medical Supply Groupings

Restricted Drug and Enteral Products

Hemophilia Blood Factor Products

Service Code Groupings

Synagis

This Computes!

 

Dental Crosswalk - CDT-4 Codes

These code lists show the local procedure codes and their equivalent CDT-4 codes.

• Local Procedure Codes to CDT-4 Codes
• CDT-4 Codes to Local Procedure Codes

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Medical Supply TOOL

Medical Supply Codes Requiring a Product Specific SAR.

• Medical Supply Tool

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Restricted Drug and Enteral Products

These tools are updated quarterly and may not reflect newer products or package sizes. They should be used as reference only.

• CCS/GHPP Restricted Drug and Enteral Nutrition Products List (April 2012)
  This list is intended to serve as a quick reference for identifying drugs and enteral nutrition products that have been restricted by CCS or GHPP. The information is only accurate as of the first day of the month shown.
• CCS Restricted Enteral Nutrition Products List (March 11, 2011)
  This list is intended to provide general product information.  It also serves as a quick reference for identifying Medical "contracted" enteral nutrition products.
• Nutrition Related Products That Are Not Restricted (September 1, 2010)
• Regular Infant Formulas: Medi-Cal Non-Benefit Status-TAR2 (September 2007)
  This list is intended to provide a list of non-benefit regular infant formulas.
• Enteral Nutrition: List of Contracted Products Available (list begins on page 8)
  Listed by manufacturer and specific product category. Link above is to the Medi-Cal Provider Manual's List of Contracted Enteral Products.  Contracted product categories include: standard, diabetic, and metabolic, and specialty infant enteral nutrition.

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Hemophilia Blood Factor Products

• DHCS Contracted Providers of Hemophilia Blood Factor Products (June 2012)

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Service Code Groupings (SCGs)

Note that though all FDA approved drugs are contained in the Service Code Groupings (excluding drugs that require specific authorization by CCS), all the drugs do not appear in the lists due to space constraints. A complete list of drugs that require specific authorization by CCS can be found on the Medi-Cal website. 

These code lists continue to require revisions. “This Computes!” will alert you when the code lists are updated.

Service Code Groupings - Medical

Note: The list below is not complete and should be used as reference only; the Medi-Cal website contains the most current list of codes in the individual SCGs.

• SCG 01 - Physician
• SCG 02 - Special Care Center 
• SCG 03 - Transplant Center
• SCG 04 - Communications Center
• SCG 05 - Cochlear Implant
• SCG 06 - High Risk Infant Follow-Up
• SCG 07 - Orthopedic
• SCG 08 - Rural Health Clinics & Federally Qualified Health Centers
• SCG 09 - Chronic Dialysis Clinic
• SCG 10 - Ophthalmology
• SCG 11 - Medical Therapy
• SCG 12 - Podiatry

Service Code Groupings - Dental

Note: The Denti-Cal website contains the most current list of codes in the individual SCGs.

• Dental SCG
• Dental SCG: CDT-4 Codes

 

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Synagis

• Synagis Calculator

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