Statutes, codes, and regulations
California Code Of Regulations
Title 22 - Social SecurityDivision 3 - Health Care ServicesSubdivision 1 - California Medical Assistance ProgramChapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51331 - Hospital Outpatient Department Services and Organized Outpatient Clinic Services

Cal. Code Regs. tit. 22 § 51331

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Current through Register 2024 Notice Reg. No. 49, December 6, 2024
Section 51331 - Hospital Outpatient Department Services and Organized Outpatient Clinic Services
(a) Hospital outpatient department services and organized outpatient clinic services are covered to the extent listed:
(1) Physician
(2) Optometric
(3) Psychology
(4) Podiatric
(5) Physical therapy
(6) Occupational therapy
(7) Speech pathology
(8) Audiology
(9) Acupuncture
(10) Dental
(11) Laboratory and X-ray
(12) Blood and blood derivatives
(13) Chronic hemodialysis
(14) Hearing aids
(15) Prosthetic and orthotic appliances
(16) Durable medical equipment
(17) Medical supplies
(18) Prescribed drugs
(19) Use of an emergency, examining, or treatment room or other hospital facilities included in Section 51509(g), when required for the provision of a covered physician's service.
(20) Adult Day Health Care
(b) Physician services in a hospital outpatient department or clinic are subject to the requirements of Sections 51305 through 51305.7. Services indicated in (6) through (8) above are subject to the limitations specified in Section 51304(a). Podiatry services, except as otherwise specified in Section 51310(a)(1), and physical therapy services are covered only if prior authorization is obtained from the Medi-Cal consultant. The services set forth above are subject to the same limitations that apply when such services are provided in a nonhospital or nonclinic setting.
(c) Organized outpatient clinic services shall be covered only for services provided to outpatients at the clinic site. Medical staff of organized outpatient clinics who wish to provide and be reimbursed for ongoing care to a clinic patient who has been admitted to a health facility, or who is confined to his or her residence must obtain and use individual or group physician provider numbers. They must also separately bill the program for these out-of-clinic services utilizing their individual provider numbers with the appropriate place of service indicated.
(d) Drugs dispensed by a licensed nonprofit community or free clinic for use at home shall be covered only if the clinic has obtained a permit pursuant to Business and Professions Code Section 4063 et seq. All drugs dispensed to Medi-Cal patients by clinics with special permits shall be subject to the provisions of Sections 51313 and 51313.3 as applicable.

Cal. Code Regs. Tit. 22, § 51331

1. Amendment filed 5-14-76 as an emergency; effective upon filing (Register 76, No. 20). For prior history, see Register 72, No. 18.
2. Certificate of Compliance filed 9-8-76 (Register 76, No. 37).
3. New subsection (a)(19) filed 6-28-78 as an emergency; designated effective 7-1-78 (Register 78, No. 26).
4. Amendment filed 9-4-80; effective thirtieth day thereafter (Register 80, No. 36).
5. Amendment of subsection (a) filed 4-30-81; effective thirtieth day thereafter (Register 81, No. 18).
6. Amendment of subsection (b) filed 9-1-82 as an emergency; effective upon filing (Register 82, No. 37). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-30-82.
7. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83 (Register 83, No. 6).
8. New subsection (c) filed 9-10-86; effective thirtieth day thereafter (Register 86, No. 37).
9. Change without regulatory effect of NOTE (Register 86, No. 49).
10. New subsection (d) and amendment of NOTE filed 1-6-94; operative 2-7-94 (Register 94, No. 1).
11. Change without regulatory effect amending subsection (b) and NOTE filed 8-18-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 34).

Note: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institutions Code; Section 57(c), Chapter 328, Statutes of 1982; and Sections 20 and 208, Health and Safety Code. Reference: Sections 14053, 14131, 14132, 14132.03, 14133, 14133.1, 14133.3 and 14133.25, Welfare and Institutions Code; Section 52, Chapter 328, Statutes of 1982; Section 149, Chapter 323, Statutes of 1983; and Section 4063, Business and Professions Code.

1. Amendment filed 5-14-76 as an emergency; effective upon filing (Register 76, No. 20). For prior history, see Register 72, No. 18.
2. Certificate of Compliance filed 9-8-76 (Register 76, No. 37).
3. New subsection (a)(19) filed 6-28-78 as an emergency; designated effective 7-1-78 (Register 78, No. 26).
4. Amendment filed 9-4-80; effective thirtieth day thereafter (Register 80, No. 36).
5. Amendment of subsection (a) filed 4-30-81; effective thirtieth day thereafter (Register 81, No. 18).
6. Amendment of subsection (b) filed 9-1-82 as an emergency; effective upon filing (Register 82, No. 37). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-30-82.
7. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83 (Register 83, No. 6).
8. New subsection (c) filed 9-10-86; effective thirtieth day thereafter (Register 86, No. 37).
9. Change without regulatory effect of NOTE (Register 86, No. 49).
10. New subsection (d) and amendment of Note filed 1-6-94; operative 2-7-94 (Register 94, No. 1).
1. Amendment filed 5-14-76 as an emergency; effective upon filing (Register 76, No. 20). For prior history, see Register 72, No. 18.
2. Certificate of Compliance filed 9-8-76 (Register 76, No. 37).
3. New subsection (a)(19) filed 6-28-78 as an emergency; designated effective 7-1-78 (Register 78, No. 26).
4. Amendment filed 9-4-80; effective thirtieth day thereafter (Register 80, No. 36).
5. Amendment of subsection (a) filed 4-30-81; effective thirtieth day thereafter (Register 81, No. 18).
6. Amendment of subsection (b) filed 9-1-82 as an emergency; effective upon filing (Register 82, No. 37). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 12-30-82.
7. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83 (Register 83, No. 6).
8. New subsection (c) filed 9-10-86; effective thirtieth day thereafter (Register 86, No. 37).
9. Change without regulatory effect of NOTE (Register 86, No. 49).
10. New subsection (d) and amendment of Note filed 1-6-94; operative 2-7-94 (Register 94, No. 1).
11. Change without regulatory effect amending subsection (b) and Note filed 8-18-2014 pursuant to section 100, title 1, California Code of Regulations (Register 2014, No. 34).