Cal. Code Regs. Tit. 22, § 51504 - Comprehensive Perinatal Services
(a) Except where a capitated health system
contract entered into by the Department provides otherwise, reimbursement for
comprehensive perinatal obstetric, nutrition, psychosocial, and health
education services shall be made only to comprehensive perinatal providers
defined in Section
51179.1.
(b) Except where a capitated health system
contract entered into by the Department provides otherwise, reimbursement for
comprehensive perinatal obstetric services shall not exceed the maximum
allowances for similar services established in Sections
51503,
51509 or
51509.1, whichever is applicable,
plus the following amounts.
(1) An additional
$50.00 shall be allowed for the initial comprehensive medical office visit when
provided within 16 weeks of the last menstrual period.
(2) An additional $100.00 in total shall be
allowed for the tenth and all subsequent prenatal office
visits.
(c) Except where
a capitated health system contract entered into by the Department provides
otherwise, reimbursement for pathology services shall not exceed the maximum
allowances established in Section
51529.
(d) Except where a capitated health system
contract entered into by the Department provides otherwise, reimbursement for
comprehensive perinatal nutrition, psychosocial, and health education services
shall not exceed the maximum allowances listed in this section. Reimbursement
shall be claimed only for time spent rendering covered patient care services
while in direct personal contact with the patient. Reimbursement shall not be
claimed for similar services provided under the Maternal and Child Health
program.
(e) Reimbursement for the
combined perinatal assessment procedure listed in subsection (1) shall be
allowed only when all three indicated assessments and the initial comprehensive
medical examination have been performed.
(1)
Maximum allowances for comprehensive perinatal nutrition, psychosocial, and
health education assessment:
Procedure Code | Maximum Allowance | |
Z6500 | Initial comprehensive nutrition, psychosocial, and health education assessments and development of care plan, first 30 minutes each assessment (total of 90 minutes), including ongoing coordination of care. | $135.83 |
(2) Maximum allowances for comprehensive
perinatal nutrition services:
Z6200 | Initial nutrition assessment and development of care plan, first 30 minutes | $16.83 |
Z6202 | Initial nutrition assessment and development of care plan, each subsequent 15 minutes | 8.41 |
(Maximum of 1 1/2 hours) | ||
Z6204 | Follow-up antepartum nutrition assessment, treatment and/or intervention, individual, each 15 minutes | 8.41 |
(Maximum of 2 hours) | ||
Z6206 | Follow-up antepartum, nutrition assessment, treatment, and/or intervention, group, per patient, each 15 minutes | 2.81 |
(Maximum of 3 hours) | ||
Z6208 | Postpartum nutrition assessment, treatment, and/or intervention, including development of care plan, individual, each 15 minutes | 8.41 |
(Maximum of 1 hour) | ||
Z6210 | Prenatal vitamin-mineral supplement, 300-day supply | 39.96 |
(3) Maximum allowances for comprehensive
perinatal psychosocial services:
(4) Maximum allowances for comprehensive
perinatal health education services:
Procedure Code | Maximum Allowance | |
Z6300 | Initial psychosocial assessment and development of care plan, first 30 minutes | $16.83 |
Z6302 | Initial psychosocial assessment and development of care plan, each subsequent 15 minutes | 8.41 |
(Maximum of 1 1/2 hours) | ||
Z6304 | Follow-up antepartum psychosocial assessment, treatment and/or intervention, individual, each 15 minutes | 8.41 |
(Maximum of 3 hours) | ||
Z6306 | Follow-up antepartum psychosocial assessment, treatment and/or intervention, group, per patient, each 15 minutes | 2.81 |
(Maximum of 4 hours) | ||
Z6308 | Postpartum psychosocial assessment, treatment, and/or intervention, including development of care plan, individual, each 15 minutes | 8.41 |
(Maximum of 1 1/2 hours) | ||
Z6400 | Client orientation, each 15 minutes | 8.41 |
(Maximum of 2 hours) | ||
Z6402 | Initial health education assessment and development of care plan, first 30 minutes | 16.83 |
Z6404 | Initial health education assessment and development of care plan, each subsequent 15 minutes | 8.41 |
(Maximum of 2 hours) | ||
Z6406 | Follow-up antepartum health education assessment, treatment, and/or intervention, individual, each 15 minutes | 8.41 |
(Maximum of 2 hours) | ||
Z6408 | Follow-up antepartum health education assessment, treatment, and/or intervention, group, per patient, each 15 minutes | 2.81 |
(Maximum of 2 hours) | ||
Z6410 | Perinatal education, individual, each 15 minutes | 8.41 |
(Maximum of 4 hours) | ||
Z6412 | Perinatal education, group, per patient, each 15 minutes | 2.81 |
(Maximum of 18 hours) | ||
Z6414 | Post partum health education assessment, treatment, and/or intervention, including development of care plan, individual, each 15 minutes | 8.41 |
(Maximum of 1 hour) |
Notes
2. New section refiled 6-5-87 as an emergency; operative 6-17-87 (Register 87, No. 25). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-15-87.
3. Certificate of Compliance including amendment of subsection (d) filed 9-17-87 (Register 87, No. 38).
4. Amendment of subsection (b) filed 5-9-88 as an emergency; operative 5-15-88 (Register 88, No. 20). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 9-12-88.
5. Certificate of Compliance including amendment of subsection (b)(2) transmitted to OAL 9-1-88 and filed 10-3-88 (Register 88, No. 42).
6. Amendment of subsections (e)(1)-(e)(4) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
8. Amendment of subsections (e)(1)-(2) and (e)(4), new subsection (f) and amendment of NOTE filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats. 2000, c. 52, Items 4260-101-0001 and 0890 (Register 2002, No. 29).
9. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (f), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).
Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14075, 14077, 14105 and 14134.5, Welfare and Institutions Code; Statutes of 2000, Chapter 52, Items 4260-101-0001 and 0890.
2. New section refiled 6-5-87 as an emergency; operative 6-17-87 (Register 87, No. 25). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 10-15-87.
3. Certificate of Compliance including amendment of subsection (d) filed 9-17-87 (Register 87, No. 38).
4. Amendment of subsection (b) filed 5-9-88 as an emergency; operative 5-15-88 (Register 88, No. 20). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 9-12-88.
5. Certificate of Compliance including amendment of subsection (b)(2) transmitted to OAL 9-1-88 and filed 10-3-88 (Register 88, No. 42).
6. Amendment of subsections (e)(1)-(e)(4) filed 9-25-92 as an emergency; operative 10-1-92 (Register 92, No. 40). A Certificate of Compliance must be transmitted to OAL 1-25-93 or emergency language will be repealed by operation of law on the following day.
7. Certificate of Compliance as to 9-25-92 order transmitted to OAL 1-22-93 and filed 3-9-93 (Register 93, No. 11).
8. Amendment of subsections (e)(1)-(2) and (e)(4), new subsection (f) and amendment of Note filed 7-16-2002; operative rates for services provided on or after 8-1-2000 pursuant to Stats.
9. Certificate of Compliance as to 7-16-2002 order, including repealer of subsection (f), transmitted to OAL 11-12-2002 and filed 12-24-2002 (Register 2002, No. 52).
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