Cal. Code Regs. tit. 22 § 51504

Current through Register 2024 Notice Reg. No. 21, May 24, 2024

Section 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)

Cal. Code Regs. Tit. 22, § 51504

1. New section filed 2-17-87 as an emergency; effective upon filing (Register 87, No. 8). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 6-17-87.
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.

1. New section filed 2-17-87 as an emergency; effective upon filing (Register 87, No. 8). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 6-17-87.
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).