Skip to content

Attachment 4.19-B (Pages 1-84)

NOTE: Links on this page are documents in Adobe Acrobat Document Format (PDF); unless indicated are smaller than 2MB. PDF documents require Adobe Reader. If you need to install or upgrade to the latest version, see the “Download Free Readers” link at the bottom of the page.

Supplements to Attachment 4.19-B 

  • Supplement 1 Payment of Medicare Part A, B, and C Deductible/Coinsurance
  • Supplement 2 Payment Methodology for Prescription Drugs
  • Supplement 3 Federal Financial Participation Under New Federal Drug Rebate Program 
  • Supplement 4 Policy and Methods for Establishing Payment Rates
  • Supplement 5 Cost-Based Reimbursement
  • Supplement 6 Reimbursement for Indian Health Services and Tribal 638 Health Facilities
  • Supplement 7 Provider Based Rural Health Clinics
  • Supplement 8 Payment for Local Education Agency (LEA) Services
  • Supplement 9 Reimbursement to State-Owned Health Care Clinics For Medi-Cal Beneficiaries
  • Supplement 10 Public Freestanding Outpatient Clinics Supplemental Payment
  • Supplement 12 Supplemental Reimbursement for Hospital Outpatient Services
  • Supplement 13 Supplemental Reimbursement for Hospital Outpatient Services
  • Supplement 14 Supplemental Reimbursement for Hospital Outpatient Services
  • Supplement 15 Outpatient Providers Subject to Provider Payment Reductions
  • Supplement 16 Reimbursement for Emergency Air Medical Transportation Services
  • Supplement 17 Non-Institutional Services
  • Supplement 18 Supplemental Reimbursement For Publicly Owned or Operated Ground Emergency Medical Transportation Providers 
  • Supplement 19 Payments to Primary Care Providers: Crosswalk of Evaluation and Management Codes and Local Codes
  • Supplement 20 Payments to Primary Care Providers: Vaccine Crosswalk
  • Supplement 21 Payments to Primary Care Providers: CHDP Health Assessment and Immunization Crosswalk
  • Supplement 22 Supplemental Reimbursement for Hospital Outpatient Services
  • Supplement 23 One-time Supplemental Payment for Specified Providers
  • Supplement 24 Supplemental Payments for Hospital Outpatient Services
  • Supplement 25 One-year supplemental payment for certain dental services using California Healthcare, Research and Prevention Tobacco Tax Act funds
  • Supplement 26 Allows for time-limited supplemental reimbursements under the Family Planning, Access, Care and Treatment (Family PACT) program for the Evaluation and Management portion of office visits rendered for the purpose of comprehensive family planning services
  • Supplement 27 One-Year Supplemental Payment Program for Certain Physician Services
  • Supplement 28 Time-Limited Supplemental Payments for Family Planning, Access, Care and Treatment Program Services
  • Supplement 29 One-Year Reimbursement Rate Add-on for Ground Emergency Medical Transport Services
  • Supplement 30 Supplemental Payments for Specific Family Planning Services Under the Medi-Cal Program
  • Supplement 32 Supplemental Incentive Payments for Trauma Screenings
  • Supplement 33 Reimbursement Methodology for Diabetic Prevention Program Services 
  • Supplement 34 Time-Limited Supplemental Payment Program for Non-Emergency Medical Transportation Services
  • Supplement 35 Supplemental Payments for Hospital Outpatient Services
  • Supplement 37 California Advancing and Innovating Medi-Cal (CalAIM) Supplemental Payments for Certain Preventive Dental Services and Certain Dental Exam Services
  • Supplement 38 Supplemental Payments for Hospital Outpatient Services 
  • Supplement 39 Supplemental Payments for Hospital Outpatient Services
  • Supplement 40 Reimbursement Methodology For Primary/General Care, Obstetric Care, Doula, And Non-Specialty Outpatient Mental Health Services

Targeted Provider Reimbursement Methodology for Primary/General Care, Obstetric Care, Doula, and Nonspecialty Outpatient Mental Health Services