​Back to Back to Proposition 56 2018

Proposition 56 Supplemental Payment for Physician Services

The Centers for Medicare & Medicaid Services approved a one-year extension of the supplemental payment program for physician services provided to Medi-Cal beneficiaries. The supplemental payments are fixed amounts to be paid per claim, in addition to the base rates, for certain physician services rendered between July 1, 2018 and June 30, 2019. This supplemental payment was authorized by Senate Bill 856 (Chapter 30, Statutes of 2018) which appropriated the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds to be used as the nonfederal share for specified Department of Health Care Services health care expenditures during the 2018-19 state fiscal year.
 
The Department implemented supplemental payments for physician services in both Medi-Cal fee-for-service and Medi-Cal managed care delivery systems. Providers who are eligible to provide and bill the specified Current Procedural Terminology (CPT) codes will receive the applicable supplemental payment as listed in the chart below. Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs), and other providers that are reimbursed on a cost-based system are not eligible to receive the supplemental payment.
 
The supplemental payments are for new and established patient office/outpatient visits, psychiatric diagnostic evaluations, psychiatric diagnostic evaluation with medical services, and psychiatric pharmacological management services, as identified by the CPT codes below:
           
CPT Code
CPT Code
99201
$18.00
99381
$77.00
99202
$35.00
99382
$80.00
99203
$43.00
99383
$77.00
99204
$83.00
99384
$83.00
99205
$107.00
99385
$30.00
99211
$10.00
99391
$75.00
99212
$23.00
99392
$79.00
99213
$44.00
99393
$72.00
99214
$62.00
99394
$72.00
99215
$76.00
99395
$27.00
90791
$35.00
90863
$5.00
90792
$35.00
 
 
 

 

Last modified date: 12/4/2018 2:23 PM