Overview of CCS Medical Eligibility
This brief summary page has been developed solely for the convenience and use in understanding the general medical eligibility criteria of the CCS program. It is not an authoritative statement of, and may not be cited as authority, for any decisions, determinations, or interpretations under the CCS program.
Please refer to the California Code of Regulations, Title 22, Division 2, Subdivision 7, Chapter 3, Article 2, Sections 41515.1-41518.9 for full description. The applicable medical eligibility section is noted with each category below.
CCS applicants diagnosed with at least one of the following shall be medically eligible for participating in the CCS program:
Section 41515.2: Infectious Diseases (ICD-10 A00-B99)
Section 41516: Neoplasms (ICD-10 C00-D49)
Section 41516.1: Endocrine, Nutritional, and Metabolic Diseases, and Immune Disorders (ICD-10 E00-E89)
Section 41516.3: Diseases of Blood and Blood-Forming Organs (ICD-10 D50-D89)
Section 41517: Mental Disorders and Mental Retardation (ICD-10 F01-F99)
Section 41517.3: Diseases of the Nervous System (ICD-10 G00-G99)
Section 41517.5: Medical Therapy Program
Section 41517.7: Diseases of the Eye (ICD-10 H00-H59)
Section 41518: Diseases of the Ear and Mastoid (ICD-10 H60-H95)
Section 41518.2: Diseases of the Circulatory System (ICD-10 I00-I99)
Section 41518.3: Diseases of the Respiratory System (ICD-10 J00-J99)
Section 41518.4: Diseases of the Digestive System (ICD-10 K00-K95)
Section 41518.5: Diseases of the Genitourinary System (ICD-10 N00-N99)
Section 41518.6: Diseases of the Skin and Subcutaneous Tissues (ICD-10 L00-L99)
Section 41518.7: Diseases of the Musculoskeletal System and Connective Tissue (ICD-10 M00-M99)
Section 41518.8: Congenital Anomalies (ICD-10 Q00-Q99)
Section 41518.9: Accidents, Poisonings, Violence, and Immunization Reactions (ICD-10 S00-T88)
Perinatal Morbidity and Mortality (ICD-10 P00-P96)
Neonates who have a CCS-eligible condition and require care in a CCS-approved neonatal intensive
care unit (NICU) because of the eligible condition.
Critically ill neonates who do not have an identified CCS-eligible condition but who require one or
more of the following services in a CCS-approved NICU:
- Invasive or non-invasive positive ventilatory assistance.
- Supplemental oxygen concentration by hood of greater than or equal to 40 percent.
- Maintenance of an umbilical artery (UA) or peripheral arterial catheter (PAC) for medically necessary indications, such as monitoring blood pressure or blood gases.
- Maintenance of an umbilical venous catheter or other central venous catheter for medically necessary indications, such as pressure monitoring or cardiovascular drug infusion.
- Maintenance of a peripheral line for intravenous pharmacological support of the cardiovascular system.
- Central or peripheral hyperalimentation.
- Chest tube.
Neonates and infants who do not have an identified CCS-eligible condition but who require two or
more of the following services in a CCS-approved NICU:
- Supplemental inspired oxygen.
- Maintenance of a peripheral intravenous line for administration of intravenous fluids, blood, blood products or medications other than those used in support of the cardiovascular system.
- Pharmacological treatment for apnea and/or bradycardia episodes.
- Tube feedings.
