State Sponsored Business
Provider Bulletin
January 09, 2012
Child Health and Disability Prevention Program
National Standard Codes Replacing
Anthem Blue Cross Proprietary Codes
Physician Bulletin
This provider bulletin is an update about information in Anthem Blue Cross’ State
Sponsored Business Provider Operations Manual (Manual). For access to the latest
Manual, go online to www.anthem.com/ca.
Effective March 1, 2012 Anthem Blue Cross will require providers to use the national standard
CPT-4/HCPCS codes and the Medi-Cal local modifier SL (used with VFC vaccine codes) for all
Child Health and Disability Prevention (CHDP) program services.
Provider Qualifications for Rendering CHDP Services
In order to render CHDP services, a provider must be an active Medi-Cal provider and certified
to provide CHDP services. In addition, all Medi-Cal providers who administer vaccines to
children under the age of 19 must enroll in the Vaccines for Children (VFC) program. The VFC
vaccines may be used only for CHDP services.
It is the provider’s responsibility to apply for CHDP certification through their local CHDP state
and county offices. When applying for certification, providers should request preprinted PM-160
“Information Only” (brown) forms. A completed copy of this form must accompany each
submitted claim.
Billing Requirements for CHDP Services
Whether submitting claims via the CMS-1500 paper form or electronically via the 837P CHDP
claims submission, all providers must mail the PM-160 “Informational Only” forms to:
Anthem Blue Cross
PO Box 60007
Los Angeles, CA 90060-0007
Please be sure to retain a legible copy of this form for your records. Doing so ensures both that
the HEDIS review process will be less intrusive and the data gathered during the review is
accurate.
www.anthem.com/ca
Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California
Partnership Plan, Inc. Independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue
Cross name and symbol are registered marks of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal
Managed Care services in Los Angeles County.
1111 CAW3298MD 01/27/2012
State Sponsored Business, Anthem Blue Cross
CHDP: National Codes Replacing Proprietary Codes
January 09, 2012
Page 2 of 4
Guidelines for Completing the Claim
When completing claims for CHDP services, please use the following guidelines:
For Primary Diagnosis, please use diagnosis code V20.2 or V70.0
Primary Care Physicians: well visit services with range 99800-99808 will be replaced
with standard CPT-4 range 99381 – 99385 for new patients and 99391-99395 for
established patients.
Health Assessment Providers (School Based Clinics and Local Health Departments)
well visit services with range 99810 – 99818 will be replaced with standard CPT-4
ranges 99381 – 99385 for new patients and 99391-99395 for established patients.
Health Screening Procedures with range 99820-99825 will be replaced with the following
CPT-4 standard codes:
CPT-4 Codes
Description
S0612
Pelvic Exam-19 years up to 22 years of age
99173
Snellen Eye Test or Equivalent Visual Acuity Test age 3 yrs through
18 years of age
92552
Bi-Aural Hearing Tests-Audiometric: Pure Tone Audiometry
86580
PPD Screening-TB: Mantoux Test
For CHDP only, please continue to use HCPCS code D1203 for topical application of fluoride
on children younger than 6 years of age and up to three times in a 12- month period. (This is a
medical benefit and not dental.)
Clinical Laboratory Test services with range 99830-99840 will be replaced with standard
CPT-4 codes. All clinical laboratories must be CHDP-certified and have an active Clinical
Laboratory Improvement Amendments (CLIA) certification. There are limited lab tests that can
be drawn and analyzed in the provider’s office and providers are required to have a CLIA
Waiver certification to render these services. Additionally, there are limited lab tests by
providers that are drawn in the office and sent to the lab to receive a reimbursement.
State Sponsored Business, Anthem Blue Cross
CHDP: National Codes Replacing Proprietary Codes
January 09, 2012
Page 3 of 4
Please use the following CPT-4 standard codes appropriately when billing the correct services
rendered.
Clinical Laboratories: collection and analysis- Place of Service 81 (bill global except when
modifier is noted)
CPT-4 Codes
Description
82947
Blood glucose assay
84030
Phenylketonuria (PKU) blood test- (under 1 month of age)
81002 or 81003
Urine “Dipstick”
81007
Urinalysis, routine, complete
85660
Sickle Cell Status (Hemoglobin Electrophoresis)
82465
Total Cholesterol
83655 (26/TC)
Lead Blood Level
86592
VDRL, RPR, or ART
87590
Gonorrhea (GC) test
88150
Pap Smear
87110
Chlamydia Test
87177
Ova and/or Parasites
Primary Care and Health Assessment Providers: specimen collected and analyzed in office
requires CLIA Waiver (bill global except when modifier is noted)
CPT-4 Codes
Description
82947
Blood glucose assay
83026 or 85018
Hemoglobin or Hemotocrit
84030
Phenylketonuria (PKU) blood test- (under 1 month of age)
81002 or 81003
Urine “Dipstick”
81007
Urinalysis, routine, complete
82465
Total Cholesterol
83655 (26/TC)*
Lead Blood Level
*When certified to perform Lead Blood Level (83655) test in the office, bill code without
modifiers when performing both professional and technical components. For providers without
certification, use modifier 26 when performing the professional component only.
State Sponsored Business, Anthem Blue Cross
CHDP: National Codes Replacing Proprietary Codes
January 09, 2012
Page 4 of 4
Primary Care and Health Assessment Providers: collection and handling of specimen sent
to lab for analysis (bill global except when modifier is noted)
CPT-4 Codes
Description
82947
Blood glucose assay
83026 or 85018
Hemoglobin or Hemotocrit
85660
Sickle Cell Status (Hemoglobin Electrophoresis)
82465
Total Cholesterol
83655.26
Lead Blood Level
86592
VDRL, RPR, or ART
87590
Gonorrhea (GC) test
87110
Chlamydia Test
Immunizations and vaccines with range 99845-99868 will be replaced with standard CPT-4
codes. When billing immunizations obtained from the VFC Program, the Medi-Cal local
modifier SL is required with the appropriate CPT-4 code on each line. When the immunization is
not covered by VFC, do not use the SL modifier.
When billing for CHDP vaccines, whether VFC-related or not, please remember to always use
the standard administration fee CPT-4 codes 90460-90461 or 90471-90474 appropriately.
For More Information
You can find related information on our website; go to www.anthem.com/ca. Select Other
Anthem Websites: Providers on the bottom right, and under the heading Learn More, click
State Sponsored Plans. Under Forms and Tools, select the link for CHDP Proprietary Codes
Cross Walked to National Standard Codes.
In the future, you’ll be able to find additional related information in our Provider Operations
Manual; go to www.anthem.com/ca. Select Other Anthem Websites: Providers on the bottom
right, and under the heading Learn More, click State Sponsored Plans. Under Provider
Communications, click Provider Operations Manuals and Important Updates, and then
select the link for the provider operations manual for Medi-Cal.
If you have specific questions or want more detailed code cross walking information, please
contact your local Community Resource Coordinator (CRC):
Fresno/Madera
Los Angeles
Sacramento/Bay Area
1-559-488-1380
1-818-655-1255
1-916-325-4200
Stanislaus/San Joaquin
Tulare/Kings
1-209-558-2762
1-559-733-6578