Proposition 56 Supplemental Payment for Physician Services
| Date: | January 16, 2018 |
| To: | Health Plan of San Joaquin (HPSJ) Primary Care (PCP) & Specialist Providers |
| From: | Provider Services Department |
| Subject: | Proposition 56 Supplemental Payment for Physician Services |
| Business: | Medi-Cal Managed Care |
Period of Service Impacted: July 1, 2017 through June 30, 2018
The Department of Healthcare Services (DHCS) recently received approval from the federal Centers for Medicare & Medicaid Services (CMS) for State Plan Amendment (SPA) 17-030.
- SPA 17-030 authorizes a one year Supplemental Payment for certain physician services, funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) and matching federal funds.
- This one year period covers services from July 1, 2017 through June 30, 2018.
- Supplemental payments for the related physician services will be made based on claim submissions for specific Current Procedural Terminology – 4th Edition (CPT-4) codes.
- These codes are:
- CPT –4 Codes
90791, 90792
90863
99201, 99202, 99203, 99204, 99205
99211, 99212, 99213, 99214, 99215
- CPT –4 Codes
Please know that Health Plan of San Joaquin (HPSJ) currently is working on the payment methodologies needed to distribute this funding. We will update you as soon as we are ready to start processing the Supplemental Payments.
For additional information regarding the Proposition 56 Supplemental Payments, please refer to the “Proposition 56 Supplemental Payment methodologies PDF” on the DHCS website, at www.dhcs.ca.gov.
If you have questions, please contact our Provider Services Department at 209-942-6320 and ask for either Amanda Yang, Christina Villar or Evelyn Terra.