Proposition 56 Pregnancy Termination Services Supplemental Payment
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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 | Prop 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.