Author Topic: Help needed with Medi-Cal Rates  (Read 29 times)

socorros

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Help needed with Medi-Cal Rates
« on: December 12, 2017, 01:35:47 PM »
Hello,

I'm new to this forum, and I am by no means in the medical billing profession so please excuse my ignorance!  I need to do some calculations to see approximately what Medi-Cal would've paid for various services if the patient had utilized Medi-Cal as opposed to attorney liens. I'm trying to use the Medi-Cal Rate site where you can look up CPT codes and find the unit value, basic rate, conversion index, etc (https://files.medi-cal.ca.gov/pubsdoco/Rates/rates_range_display.asp). I also found the Medi-Cal Notes to Rates page (https://files.medi-cal.ca.gov/pubsdoco/Rates/rates_notes.asp) but I'm having trouble figuring out how to actually do the calculations. 

Are both unit value AND basic rate added together, or is it one or the other?  Do you multiply unit value times conversion factor (as opposed to conversion index)? Seems like you're supposed to use the conversion chart (https://files.medi-cal.ca.gov/pubsdoco/rates/rates_conv_factors.asp) to find the conversion factor based on the conversion index & facility type. What number do you multiply the prof % based on?

If anyone is familiar with this and is willing and able, it would be super helpful to see just one example, such as based on the CPT code 99205 (office visit, new patient - with physician).

If you're able to help, I give you a million thanks in advance.



Michele

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Re: Help needed with Medi-Cal Rates
« Reply #1 on: December 13, 2017, 07:21:13 AM »
I'm not sure I understand what exactly you are asking for.  Are you looking for allowed amounts for certain CPT codes or are you looking for how they calculate those amounts?
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