Billing > Billing

Medi-Cal (CA Medicaid) Conversion Indicators

(1/1)

BillerJess:
Help me to understand what is going on with Medi-Cal...

I'm researching this cpt: 11042 (debridement), also please note I am using Modifier AG to denote primary surgical procedure.
 
Per the Medi-Cal fee schedule/conversion indicators the allowable should be $37.23.  However we seem to be getting reimbursed $83.77 (paying w/RAD 0414 pymt reduced after review)

My concern with this payment comes from us billing a Medi-Cal HMO product who uses the Medi-Cal fee schedule to price claims who has suddenly began pricing this cpt as $0.00.  I am now left to appeal these claims, but first I want to ensure I understand exactly how Medi-Cal is getting their allowable.

Any help is appreciated!!

BillerJess:
Just in the event anyone else is searching for this answer, I did find out.  The fiscal intermediary prices these based off certain criteria.. so finding one set number is basically impossible. :|

Navigation

[0] Message Index