MedicaidBilling CodesMedium impact
22-267 Bill E&M Services Correctly with New Payment Policy to Avoid Payment Delays
Health Net·CA·Prior Authorization
Effective date
Jun 8, 2022
We identified it
Jun 20, 2026
Summary
CalViva Health (Medi-Cal) will no longer reimburse facility E&M charges when billed with treatment room revenue codes 760, 761, and 769. Claims with incorrect coding combinations will be denied effective June 8, 2022.
Action Required
Immediately: Billing team must stop billing facility E&M services with revenue codes 760, 761, or 769. Update billing system edits to flag these combinations before submission. Only use treatment room revenue codes for actual procedures performed in treatment rooms, not office-based E&M services. Claims with incorrect coding will be denied by CalViva Health.