Wiki IEHP Medi-Cal IE codes

[resmedicalbilling@gmail.com]

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.

 

[SharonCollachi]

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

 

[resmedicalbilling@gmail.com]

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.