Proposition 56 Physicians Supplemental Payment
Back to Proposition 56 | Managed Care Directed Payment
Overview
This program provides supplemental payments for certain eligible physician services provided to Medi-Cal beneficiaries. The supplemental payments are provided for eligible physician services rendered on or after July 1, 2017. The base rates for these services will remain unchanged.
Providers who are eligible to provide and bill for the following Current Procedural Terminology (CPT) codes will receive the associated supplemental payment identified below, in addition to whatever other payment they receive.
| CPT Code | Supplemental Amount | CPT Code | Supplemental Amount |
|---|---|---|---|
| 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 |
The Centers for Medicare & Medicaid Services (CMS) approved SPA 21-0004 for the continuation of the supplemental reimbursement program for eligible services provided to Medi-Cal beneficiaries, effective for dates of services on or after January 1, 2022.