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As the COVID-19 pandemic continues to evolve, the Department of Health Care Services (DHCS) in California continues to monitor and assess appropriate action while working with its program partners and state and federal officials. This is to ensure that all Medi-Cal beneficiaries have access to Medically Necessary, COVID-19 testing and treatment.
According to DHCS, all enrolled Medi-Cal beneficiaries, including undocumented beneficiaries will be covered through emergency Inpatient (IP) or Outpatient (OP) medical services, as appropriate, to treat an emergency medical condition that may result in the following:
• Placing the patient’s health in serious jeopardy
• Serious impairment to bodily functions
• Serious dysfunction to any bodily organ or part
This may also apply to services rendered outside the hospital emergency department. In addition, there is no cost sharing for emergencies such as testing, evaluation and treatment for COVID-19.
For Providers, when billing for emergency COVID-19 testing and treatment services in an Office or Outpatient setting, there should be an Emergency Indicator “Y” in field/box 24 of the CMS-1500 claim form and Emergency Indicator “81” on the UB-04 form. For institutional setting such as ED, hospital Outpatient/Diagnostic and Treatment Center and hospital Inpatient including federally qualified health centers, rural health centers, and tribal health 638 clinics, it should be reported as Type of Admission Code “1” in field 14 of the UB-04 form to indicate emergency. In addition, Providers must also indicate emergency treatment on the claim and include the following statement “Patient impacted by COVID-19” and incorporate appropriate clinical information about the patient’s condition and why the emergency services rendered were considered necessary. Furthermore, the statement must be signed by the provider.
For further guidance, please visit DHCS’ website at:
As of June 19, 2020, the State of CA has taken extra steps to ensure that any person(s) who doesn’t have health insurance coverage, can qualify for Medi-Cal benefits for COVID-19 testing and treatment at “no-cost.” In addition, people who have private insurance and are not covered for COVID-19 testing and treatment can also qualify. Medi-Cal beneficiaries are also eligible for no-cost, COVID-19 testing and treatment, even if they usually have a cost sharing for lab work.
APS will continue to monitor and will provide updates as soon as the information becomes available.