Skip to Main Content

​​​​​​Proposition 56 ​​Pregnancy Termination Services​​ Supplemental Payment​

​​​Back to Directed Payments​

​​​​Overview

DHCS appropriated $10 million (all Proposition 56), to reimburse providers through supplemental payments for medical pregnancy termination services in both the Medi-Cal FFS and Medi-Cal managed care delivery systems.

Methodology​​

Providers who are eligible to provide services, can bill the following CPT codes and receive a supplemental payment in the amount identified below for the Medi-Cal FFS delivery system:

CPT Code​
 Reimbursement Rate on Medi-Cal Fee Schedule​​
 Pro​​p 56 Supplemental Payment Amount

Total Reimbursement Not to Exceed Amount

59840$250.85$149.15$400
59841$354.43$345.57$700

​For the Medi-Cal managed care delivery system, DHCS is requiring MCPs, or their delegated entities and subcontractors, to pay providers at least the rate for Current Procedural Terminology – 4th Edition (CPT-4) code 59840 in the amount of $400 and CPT-4 code 59841 in the amount of $700 for such rendered services. This payment obligation applies to both contracted and non-contracted providers. DHCS has accounted for this reimbursement requirement in capitation rates developed for MCPs.

Resources​


Last modified date: 4/23/2025 9:26 AM