resmedicalbilling@gmail.com
Contributor
Does anyone bill EIHP Medi-cal for physical therapy services? I am getting denials for the initial evaluation codes (97161-97163). Apparently, they use X codes. Greatly appreciate any input on this.
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki IEHP Medi-Cal IE codes
- Thread starter resmedicalbilling@gmail.com
- Start date
SharonCollachi
Guest
From your location, I am guessing IEHP Medi-Cal means Inland Empire Health Plan Medi-Cal. If I'm wrong, let me know and I'll hit more research.
They do offer a learning portal, accessible with free registration: https://learn.medi-cal.ca.gov/
They also have Regional Representatives to assist with billing needs or other training: 1-800-541-5555, tell them you need a Regional Representative to contact you.
There is also a Small Provider Billing Unit, for providers who bill less than 100 claim lines per month. Call 916-636-1275 or 800-541-5555, and ask about enrolling in the SPBU Billing Assistance and Training Program.
This information is for all Medi-Cal products:
Codes and Rates Physical therapy services are reimbursed as listed below: (click for link)
HCPCS Code ... Description... Maximum Allowance
X3900 Single modality to one area – initial 30 minutes $ 17.04
X3902 Single modality to one area – each additional 15 minutes 3.63
X3904 Single procedure to one area – initial 30 minutes 21.19
X3906 Single procedure to one area – each additional 15 minutes 6.86
X3908 Treatment including a combination of any modalities 21.19
and procedures (one or more areas) – initial 30 minutes
X3910 Treatment including a combination of any modalities 6.86
and procedures (one or more areas) – each additional 15 minutes
X3912 Hubbard Tank – initial 30 minutes 34.84
X3914 Hubbard Tank – each additional 15 minutes 6.86
X3916 Hubbard Tank or pool therapy with $ 41.69
therapeutic exercise – initial 30 minutes
X3918 Hubbard Tank or pool therapy with therapeutic exercise – 6.86
each additional 15 minutes
X3920 Any of the tests and measurements – initial 30 34.84
minutes, plus report
X3922 Any of the tests and measurements – each additional 17.04
15 minutes, plus report
X3924 Physical Therapy Preliminary Evaluation rehabilitation 34.84
center, SNF, ICF
X3926 Case conference and report – initial 30 minutes 21.19
X3928 Case consultation and report 21.19
X3930 Case conference and report – each additional 15 minutes 6.86
X3932 Home or long term care facility visit – add 6.57
X3934 Mileage, per mile one-way beyond 10-mile radius 1.77
of point of origin (office or home)
X3936 Unlisted services By Report
They do offer a learning portal, accessible with free registration: https://learn.medi-cal.ca.gov/
They also have Regional Representatives to assist with billing needs or other training: 1-800-541-5555, tell them you need a Regional Representative to contact you.
There is also a Small Provider Billing Unit, for providers who bill less than 100 claim lines per month. Call 916-636-1275 or 800-541-5555, and ask about enrolling in the SPBU Billing Assistance and Training Program.
This information is for all Medi-Cal products:
Codes and Rates Physical therapy services are reimbursed as listed below: (click for link)
HCPCS Code ... Description... Maximum Allowance
X3900 Single modality to one area – initial 30 minutes $ 17.04
X3902 Single modality to one area – each additional 15 minutes 3.63
X3904 Single procedure to one area – initial 30 minutes 21.19
X3906 Single procedure to one area – each additional 15 minutes 6.86
X3908 Treatment including a combination of any modalities 21.19
and procedures (one or more areas) – initial 30 minutes
X3910 Treatment including a combination of any modalities 6.86
and procedures (one or more areas) – each additional 15 minutes
X3912 Hubbard Tank – initial 30 minutes 34.84
X3914 Hubbard Tank – each additional 15 minutes 6.86
X3916 Hubbard Tank or pool therapy with $ 41.69
therapeutic exercise – initial 30 minutes
X3918 Hubbard Tank or pool therapy with therapeutic exercise – 6.86
each additional 15 minutes
X3920 Any of the tests and measurements – initial 30 34.84
minutes, plus report
X3922 Any of the tests and measurements – each additional 17.04
15 minutes, plus report
X3924 Physical Therapy Preliminary Evaluation rehabilitation 34.84
center, SNF, ICF
X3926 Case conference and report – initial 30 minutes 21.19
X3928 Case consultation and report 21.19
X3930 Case conference and report – each additional 15 minutes 6.86
X3932 Home or long term care facility visit – add 6.57
X3934 Mileage, per mile one-way beyond 10-mile radius 1.77
of point of origin (office or home)
X3936 Unlisted services By Report
resmedicalbilling@gmail.com
Contributor
Hi Sharon,
You are correct. It is through Inland Empire Health Plan. Thank you for all the information. I have made a few telephone calls hoping to get some answers.
You are correct. It is through Inland Empire Health Plan. Thank you for all the information. I have made a few telephone calls hoping to get some answers.