california children’s services (ccs) program service code ...€¦ · 01.07.2004 ·...

California Children’s Services (CCS) Program cal child ser Service Code Groupings 1

2 – California Children’s Services (CCS) Program Service Code Groupings April 2020

This section identifies California Children’s Services (CCS) Service Code Groupings (SCGs). An SCG is a group of procedure codes authorized to a CCS-approved provider for the provision of a group of related health care services that are authorized through the Service Authorization Request (SAR) process. An SCG SAR enables the provider to render care to a CCS client without obtaining repeated procedure-specific SARs. The following effective dates are listed throughout the section:

e July 1, 2004 g September 1, 2010 h January 1, 2019 b June 1, 2019 j January 1, 2020

INCLUDE SERVICE CODE GROUPS 01 THROUGH 12 Physician Service The following is a list of codes that comprise SCG 01 for physicians. Code Group 01

Authorized HCPCS Codes in Physician SCG 01

A4217 A4566 A4648 A4650 A5056 A5057 A9273 A9500–A9505 A9507–A9510 A9512 A9516 A9517 A9521 A9524 A9526–A9532 A9536–A9548 A9550–A9554 A9556–A9564 A9566 A9567 A9569–A9572 A9576–A9585 A9600 A9604 A9698 A9699 C1749 C1830 C2634 C2635 C2637–C2641 C2698 C2699

C8929–C8936 C9016 C9024 C9028 C9029 C9270 C9279 C9285 C9366 C9367 C9377 C9444 C9446 C9447 C9488 C9492 C9493 D0251 E0446 G0108 G0109 G0432 G0433 G0435–G0439 G0477–G0483 G0500 G3001

G8633–G8681 G8684 G8686–G8693 G9892–G9897 G9899 G9900 G9902–G9909 G9911–G9913 G9915 G9937 J0129 J0131–J0133 J0135 J0152 J0153 J0171 J0180 J0190 J0207 J0210 J0278–J0285 J0287–J0290 J0300 J0330 J0348 J0360 J0380 J0400 J0456 J0461 J0470 J0475 J0480 J0490

J0500 J0515 J0520 J0558 J0561 J0565 J0595–J0598 J0604 J0630 J0636 J0600 J0638 J0640 J0670 J0690 J0696 J0702 J0710 J0712 J0714 J0718 J0720 J0725 J0735 J0740 J0745 J0760 J0775 J0780 J0795 J0800 J0833 J0834

J0840 J0875 J0878 J0881 J0882 J0885 J0887 J0888 J0894 J0895 J0945 J1020 J1030 J1040 J1100 J1050 J1051 J1055 J1094 J1110 J1120 J1160 J1162 J1165 J1170 J1200 J1205 J1230 J1250 J1260 J1265 J1267

cal child ser 2


Authorized HCPCS Codes in Physician SCG 01 (continued)

J1270 J1290 J1300 J1320 J1364 J1380 J1410 J1439–J1441 J1443 J1451 J1453 J1455 J1458 J1460 J1555 J1559 J1560 J1571 J1573 J1580 J1600 J1610 J1626 J1627 J1630 J1631 J1640 J1642 J1644 J1650 J1655 J1680 J1720 J1726 J1729 J1730 J1740 J1741 J1743 J1745 J1750 J1756 J1786 J1790 J1800

J1810 J1815 J1817 J1826 J1833 J1840 J1850 J1930 J1931 J1940 J1945 J1953 J1990 J2001 J2010 J2060 J2150 J2175 J2210 J2248 J2250 J2265 J2270 J2274 J2278 J2300 J2310 J2315 J2322 J2323 J2325 J2350 J2357 J2358 J2360 J2370 J2400 J2405 J2407 J2425 J2426 J2430 J2469 J2501 J2503–J2505

J2507 J2515 J2545 J2550 J2560 J2562 J2590 J2650 J2675 J2680 J2690 J2700 J2704 J2710 J2720 J2724 J2760 J2765 J2778 J2780 J2785 J2792–J2794 J2796 J2800 J2805 J2850 J2910 J2916 J2920 J2930 J2950 J2995 J2997 J3010 J3070 J3090 J3095 J3105 J3230 J3240 J3243 J3260 J3262 J3285 J3300

J3301 J3303 J3315 J3357 J3358 J3360 J3370 J3385 J3396 J3410 J3420 J3430 J3475 J3486–J3488 J3490 J7030 J7040 J7042 J7050 J7060 J7070 J7120 J7121 J7131 J7296 J7309–J7312 J7321 J7325 J7336 J7345 J7512 J7605 J7606 J7611 J7613 J7639 J7665 J7686 J8705 J9000 J9001 J9022 J9023 J9025 J9027

J9033 J9035 J9041 J9045 J9055 J9070 J9120 J9150 J9160 J9171 J9175 J9185 J9201 J9203 J9206–J9209 J9213 J9214 J9260 J9261 J9263 J9264 J9266 J9270 J9280 J9285 J9303 J9305 J9310 J9320 J9328 J9330 J9355 J9370 J9390 J9395 P9010–P9012 P9016 P9017 P9019–P9023 P9031–P9041 P9043–P9048 P9073 P9100

cal child ser 3


Authorized HCPCS Codes in Physician SCG 01 (continued)

P9050–P9060 Q0111–Q0113 Q0138 Q0139 Q0144 Q0162 Q0166 Q2033 Q2035–Q2039 Q2043 Q3014 Q4117–Q4129 Q4176–Q4182 Q5103 Q5104 Q9951 Q9953–Q9968 S0017 S0020 S0077 S0080

S0190 S0191 S0119 S0145 S0164 S0169 S0189 S0265 S3713 S3860 S3862 T1014 X4522 X5672 X5676 X5854 X5856 X6042 X6258 X6408 X7025

X7026 X7436 X7490 X7512 X7638 X7706 X7708 X7710 X7720 X9922 X9924 X9926 X9928 X9930 X9932 X9934 X9936 X9938 X9940 X9942 X9944

X9946 X9948 X9950 X9952 X9954 X9956 X9958 X9960 X9962 X9964 X9966 X9968 X9970 Z0100 b Z0102 b Z0104 b Z0106 b Z0108 b Z0306 Z0324 h Z0326 h

Z0328 h Z0329 h Z7500 Z7502 Z7504 Z7506 Z7508 Z7510 Z7512 Z7514 Z7600 Z7602 Z7610 Z7612

cal child ser 4

2 – California Children’s Services (CCS) Program Service Code Groupings May 2019

Authorized CPT® Codes in Physician SCG 01 (continued)

00100 00102–00104 00120 00124 00126 00140 00142 00144 00145 00147 00148 00160 00162 00164 00170 00172 00174 00176 00190 00192 00210–00212 00214–00216 00218 00220 00222 00300 00320 00322 00326 00350 00352 00400 00402 00404 00406 00410

00450 00452 00454 00470 00472 00474 00500 00520 00522 00524 00528–00530 00532 00534 00537 00539–00542 00546 00548 00550 00560–00563 00566 00567 00580 00600 00604 00620 00622 00625 00626 00630 00632 00634 00635 00640 00670 00700 00702

00730 00731 00732 00750 00752 00754 00756 00770 00790 00792 00794 00796 00797 00800 00802 00811–00813 00820 00830 00832 00834 00836 00840 00842 00844 00846 00848 00851 00860 00862 00864–00866 00868 00870 00872 00873 00880 00882

00902 00904 00906 00908 00910 00912 00914 00916 00918 00920–00922 00924 00926 00928 00930 00932 00934 00936 00938 00940 00942 00944 00948 00950 00952 01112 01120 01130 01140 01150 01160 01170 01173 01200 01202 01210 01212

01214 01215 01220 01230 01232 01234 01250 01260 01270 01272 01274 01320 01340 01360 01380 01382 01390 01392 01400 01402 01404 01420 01430 01432 01440 01442 01444 01462 01464 01470 01472 01474 01480

cal child ser 5


Authorized CPT Codes in Physician SCG 01 (continued)

01482 01484 01486 01490 01500 01502 01520 01522 01610 01620 01622 01630 01634 01636 01638 01650 01652 01654 01656 01670 01680 01710 01712 01714 01716 01730 01732 01740 01742 01744 01756 01758 01760 01770 01772 01780 01782 01810 01820 01829 01830 01832 01840 01842 01844 01850 01852 01860 01916 01920

01922 01924–01926 01930–01933 01935 01936 01951–01953 01958 01960–01963 01965–01969 01990–01992 01996 01999 10021 10022 10035 10036 10040 10060 10061 10120 10121 10140 10160 10180 11000 11001 11004–11006 11008 11042–11047 11055–11057 11100 11101 11200 11201 11400–11404 11406 11420–11424 11426 11440–11444 11446 11600–11604 11606 11620–11624 11626 11640–11644 11646 11720 11721 11730 11732

11740 11750 11752 11760 11762 11765 12001 12002 12004–12007 12011 12013–12018 12020 12021 12031 12032 12034–12037 12041 12042 12044–12047 12051–12057 13100–13102 13120–13122 13131–13133 13150–13153 13160 14000 14001 14020 14021 14040 14041 14060 14061 14301 14302 14350 15851 16000 16020 17000 17003 17004 17106 17107 17110 17111 17250 20939 21011 21012

26010 26011 29049 29055 29058 29065 29075 29085 29105 29125 29126 29130 29131 29200 29240 29260 29280 29305 29325 29345 29355 29358 29365 29405 29425 29435 29440 29445 29450 29505 29515 29520 29530 29540 29550 29580 29581 29590 29700 29705 29710 29720 29730 29740 29750 30000 30020 30200 30300 30901

30903 30905 30906 31000 31002 31231 31241 31253 31257 31259 31298 31500 31502 31603 31605 31622–31638 31640 31641 31643 31645 31646 31656 32421 32422 32550–32552 32560–32562 33929 34707 34708 34712–34714 36000 36400 36405 36406 36410 36420 36425 36500 36510 36555–36558 36560 36561 36563 36565 36566 36568–36571 36575 36576

cal child ser 6



36578 36580–36585 36589 36590 36593 36595–36598 36600 36620 36625 36640 36660 36680 37252 37253 38220 38221 38222 38300 38500 38505 35873 40800 40804 40808 40819 40820 40830 40831 41000 41005 41800 42000 43234–43237 43239 43286–43288 43753–43757 43760 43761 46600 47531 47532 49082–49084 49440–49442 49446 49450–49452 49460 49465 50430 50431 51100–51102 51600

51605 51610 51700 51701–51703 51705 51710 51725–51729 51736 51741 51784 51785 51792 51797 51798 53600 53601 53620 53621 53660 53661 53855 53860 54000 54050 54055–54057 54060 54065 54500 55874 56442 57400 57410 57415 61000 61001 61070 62267 62270 62272 62284 62290 62291 62304 62305 62310 62311 62318 62319 62369 62370 64450

64455 64461–64463 64486–64489 64632 65205 65210 65220 65222 65430 65435 65800 65805 67500 67515 67700 67710 67715 67800 67801 67805 67810 67820 67840 67850 67930 67935 67938 68020 68040 68100 68110 68200 68801 68810 68840 69000 69020 69100 69105 69200 69209 69210 69420 70010 70015 70030 70100 70110 70120 70130 70134

70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70360 70370 70380 70390 70450 70460 70470 70480–70482 70486–70488 70490–70492 70496 70498 70540 70542–70549 70551–70553 70557–70559 71040 71045–71048 71060 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550–71552 71555 72020 72040 72050

72052 72070 72072 72074 72080–72084 72100 72110 72114 72120 72125–72133 72141 72142 72146–72149 72156–72159 72170 72190–72198 72200 72202 72220 72240 72255 72265 72270 72275 72285 72295 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200–73202 73206 73218–73223 73225 73501–73503

cal child ser 7



73521–73523 73525 73551 73552 73560 73562 73564 73565 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700–73702 73706 73718–73723 73725 74018 74019 74021 74022 74150 74160 74170 74174–74178 74181–74183 74185 74190 74210 74220 74230 74235 74240 74241 74245–74247 74249–74251 74260 74270 74280 74283 74290 74300 74301 74328–74330 74340

74355 74360 74363 74400 74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74485 74710 74740 74775 75600 75605 75625 75630 75650 75660 75662 75665 75671 75676 75680 75685 75705 75710 75716 75726 75731 75733 75736 75741 75743 75746 75756 75774 75791 75801 75803 75805 75807 75809 75810 75820

75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75984 75989 76000 76001 76010 76080 76098 76100–76102 76120 76125 76140 76380 76496–76499 76506 76510–76514 76516 76519 76529 76536 76604 76641 76642 76700 76705 76770 76775 76776 76800–76802 76805 76810–76812 76815–76817 76820 76821 76825–76828

76830 76831 76856 76857 76870 76872 76873 76885 76886 76930 76932 76937 76940–76942 76946 76965 76970 76975 76998 76999 77001–77003 77011–77014 77021 77022 77031 77032 77051–77059 77061–77063 77071–77077 77080 77081 77085 77086 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075 78099 78102–78104 78110 78111 78120–78122

78130 78135 78140 78185 78191 78195 78199 78201 78202 78205 78206 78215 78216 78226 78227 78230–78232 78258 78261 78262 78264 78270–78272 78278 78282 78290 78291 78299 78300 78305 78306 78315 78320 78399 78414 78428 78445 78453 78454 78456–78458 78466 78468 78472 78579 78582 78597 78598 78600 78601 78605

cal child ser 8

2 – California Children’s Services (CCS) Program Service Code Groupings January 2018


78606 78609 78610 78630 78635 78645 78650 78660 78699–78701 78707–78709 78725 78730 78740 78761 78799–78802 78804–78806 78808 78990 78999 79005 79101 79200 79300 79403 79440 79445 79900 79999 80047 80048 80051 80053 80055 80061 80069 80074 80076 80150 80156–80158 80162–80165 80168 80170 80173 80176 80178 80184–80186

80188 80190 80192 80194 80195 80197 80198 80200–80202 80299–80304 80320–80377 81000–81003 81005 81007 81015 81025 81050 81099 81105–81112 81120 81121 81175 81176 81230–81232 81238 81247–81249 81258 81259 81269 81283 81328 81334 81335 81346 81361–81364 81448 81520 81521 81541 81551 82009 82010 82013 82016 82017 82024 82030

82040 82042–82045 82085 82088 82103–82108 82120 82127 82128 82131 82135 82136 82139 82140 82143 82150 82154 82157 82160 82163 82164 82172 82175 82180 82232 82239 82240 82247 82248 82252 82261 82270–82272 82274 82286 82300 82306 82308 82310 82330 82331 82340 82355 82360 82365 82370 82373–82376 82378–82380

82382–82384 82387 82390 82397 82415 82435 82436 82438 82441 82465 82480 82482 82485 82495 82507 82523 82525 82528 82530 82533 82540 82542 82550 82552–82554 82565 82570 82575 82585 82595 82600 82607 82608 82610 82615 82626 82627 82633 82634 82638 82652 82656–82658 82664 82668 82670–82672 82677 82679

82693 82696 82705 82710 82715 82725 82726 82728 82731 82735 82746 82747 82759 82760 82775 82776 82784 82785 82787 82788 82800 82803 82805 82810 82820 82930 82938 82941 82943 82945–82948 82950–82952 82955 82960 82962 82963 82965 82977–82979 82985 83001–83003 83009

cal child ser 9



83010 83012–83015 83018 83020 83021 83026 83030 83033 83036 83045 83050 83051 83060 83065 83068–83070 83080 83088 83090 83150 83491 83497 83498 83500 83505 83516 83518–83520 83525 83527 83528 83540 83550 83570 83582 83586 83593 83605 83615 83625 83630–83633 83655 83661–83664 83670 83690 83695

83698 83700 83701 83704 83718 83719 83721 83727 83735 83775 83785 83789 83825 83835 83857 83861 83863 83864 83872–83874 83876 83880 83883 83885 83890–83894 83896–83898 83900–83909 83912–83916 83918 83919 83921 83930 83935 83945 83951 83970 83986 83987 83992 83993 84030 84035 84060 84066 84075

84078 84080 84081 84085 84087 84100 84105 84106 84110 84112 84119 84120 84126 84132–84135 84138 84140 84143 84144 84146 84150 84152–84157 84160 84163 84165 84166 84181 84182 84202 84203 84206 84207 84210 84220 84228 84233–84235 84238 84244 84252 84255 84260 84270 84275 84285 84295

84300 84302 84305 84307 84311 84315 84375–84379 84392 84402 84403 84425 84430 84432 84436 84437 84439 84442 84443 84445 84446 84450 84460 84466 84478–84482 84484 84485 84488 84490 84510 84512 84520 84525 84540 84545 84550 84560 84577 84578 84580 84583 84585 84588 84590 84591

84597 84600 84620 84630 84681 84702–84704 84830 84999 85002 85004 85007–85009 85013 85014 85018 85025 85027 85032 85041 85044–85046 85048 85049 85055 85060 85097 85130 85170 85175 85210 85220 85230 85240 85244–85247 85250 85260 85270 85280 85290–85293 85300–85303 85305–85307

cal child ser 10



85335 85337 85345 85347 85348 85360 85362 85366 85370 85378–85380 85384 85385 85390 85396 85397 85400 85410 85415 85420 85421 85441 85445 85460 85461 85475 85520 85525 85530 85536 85540 85547 85549 85555 85557 85576 85597 85598 85610–85613 85635 85651 85652 85660 85670 85675 85705

85730 85732 85810 85999–86001 86003 86008 86021–86023 86038 86039 86060 86063 86077–86079 86140 86141 86146–86148 86155–86157 86160–86162 86171 86200 86215 86225 86226 86235 86255 86256 86277 86280 86294 86300 86301 86304 86305 86308–86310 86316–86318 86320 86325 86327 86329 86331 86332 86334–86337 86340 86341 86343 86344

86353 86355–86357 86359–86361 86367 86376 86382 86384 86403 86406 86430 86431 86480 86481 86485 86486 86490 86510 86580 86590 86592 86593 86602 86603 86606 86609 86611 86612 86615 86617–86619 86622 86625 86628 86631 86632 86635 86638 86641 86644 86645 86648 86651–86654 86658 86663–86666 86668 86671

86674 86677 86682 86684 86687–86689 86692 86694–86696 86698 86701–86710 86713 86717 86720 86723 86727 86732 86735 86738 86741 86744 86747 86750 86753 86756 86757 86759 86762 86765 86768 86771 86774 86777 86778 86780 86784 86787–86790 86793 86794 86800 86803–86808 86812 86813 86816 86817 86821 86825

86826 86849 86850 86860 86870 86880 86885 86886 86900–86902 86904–86906 86920–86923 86927 86930–86932 86940 86941 86945 86960 86970–86972 86975–86978 86999 87003 87015 87040 87045 87046 87070 87071 87073 87075–87077 87081 87084 87086 87088 87101–87103 87106 87107 87109 87110 87116 87118 87140 87143 87147

cal child ser 11



87149 87150 87152 87153 87158 87164 87166 87168 87169 87172 87176 87177 87181 87184–87188 87190 87197 87205–87207 87209 87210 87220 87230 87250 87252–87255 87260 87265 87267 87269–87276 87278–87281 87283 87285 87290 87299–87301 87305 87320 87324 87327–87329 87332 87335–87341 87350 87380 87385 87389–87391 87400 87420 87425 87427 87430 87449–87451 87471 87472

87475 87476 87480–87482 87485–87487 87490–87493 87495–87498 87500–87503 87510–87512 87516 87517 87520–87522 87525–87542 87550–87552 87555–87557 87560–87562 87580–87582 87590–87592 87634 87640 87641 87650–87653 87660 87662 87797–87804 87807–87810 87850 87880 87899–87905 87906 87999 88104 88106–88108 88112 88120 88121 88130 88140–88143 88147 88148 88150 88152 88153 88155 88160–88162 88164–88167 88172–88175 88177 88182 88184 88185

88187 88189 88199 88230 88233 88235 88237 88239–88241 88245 88248 88249 88261–88264 88267 88269 88271–88275 88280 88283 88285 88289 88291 88299 88300 88302 88304 88305 88307 88309 88311–88314 88319 88321 88323 88325 88329 88331–88334 88342 88346 88348 88350 88355 88356 88358 88360–88362 88367 88368 88371 88372 88380 88381 88387 88388

88399 88720 88740 88741 88749 89050 89051 89055 89060 89125 89160 89190 89220 89230 89240 90371 90375 90376 90384 90385 90389 90461 90471 90585 90586 90587 90630 90632 90633 90636 90647–90650 90654–90658 90660 90664 90666–90668 90670 90672 90675 90680 90681 90690 90691 90696 90698 90700–90702 90707 90710 90713–90718 90723 90732

90734 90740 90743 90744 90746–90748 90756 90801 90802 90804–90819 90821–90824 90826–90829 90853 90862 90869 90899 91010 91013 91020 91022 91030 91034 91035 91037 91038 91040 91065 91110 91117 91122 91132 91133 91299 92002 92004 92012 92014 92015 92018–92020 92025 92060 92081–92083 92100 92136 92140 92225 92226 92230 92235

cal child ser 12



92240 92250 92260 92265 92270 92275 92283 92284 92310–92317 92325 92502 92504 92506–92508 92511 92512 92516 92520 92526 92531–92534 92537 92538 92540–92542 92544–92547 92550–92553 92555–92565 92567 92568 92570–92572 92575–92577 92579 92582 92585–92588 92590 92591 92594 92595 92610–92618 92620 92621 92625–92627

92630 92633 92700 92950 92953 92960 92961 92970 92971 93000 93005 93010 93015–93018 93024 93025 93040–93042 93224–93229 93268 93270 93272 93279–93299 93303 93304 93306–93308 93312 93315 93318 93320 93321 93325 93350–93352 93702 93724 93745 93750 93792 93793 93880 93882 93886

93888 93890 93892 93893 93922–93926 93930 93931 93965 93970 93971 93975 93976 93978–93981 93990 93998 94002 94003 94010–94016 94060 94150 94200 94250 94375 94400 94450 94617 94618 94621 94640 94642 94644 94645 94664 94667 94668 94680 94681 94690 94750 94760

94770 94772 95249 95806 95807 95812 95813 95816 95819 95822 95824 95827 95829–95834 95851 95852 95857 95860 95861 95863–95870 95872 95875 95885–95887 95900 95903–95905 95920 95925–95930 95934 95936–95939 95950 95951 95953 95955–95958 95970–95975 95978 95979 95991 95992 96127 96360 96361

96365–96375 96379 96401 96402 96405 96406 96409 96411 96413 96415–96417 96420 96422 96423 96425 96440 96446 96450 96521–96523 96542 96549 96573 96574 96931–96936 97010 97012 97014 97016 97018 97020 97022 97024 97026 97028 97032–97036 97039

cal child ser 13

2 – California Children’s Services (CCS) Program Service Code Groupings August 2019


97110 97112 97113 97116 97124 97127 97139 97140 97530 97533 97597

97598 97750 97763 97802–97804 97810 97811 97813 97814 99000 99070 99151–99153

99155–99157 99170 99195 99201–99205 99211–99215 99217 99221–99226 99231–99236 99238 99239 99241–99245

99251–99255 99281–99285 99291 99292 99341–99345 99347–99350 99354–99357 99415 99416 99464–99467 99477

99483 99484 99490 99492–99494 99497 99498

cal child ser 14


Special Care Centers Special Care Centers (SCCs) are identified with unique SCG 02 to Service Code Group 02 facilitate the diagnosis and treatment of CCS clients. The SCC

Service Code Group includes all codes available in preceding physician SCG 01. In addition, SCG 02 contains codes for diagnostic studies relative to SCC-unique services as follows. Authorized Codes in SCC SCG 02

HCPCS Codes

A9272 A9606 C1204 C1886 C2624 C2645 C9275 C9287 C9289 C9293 C9295 C9442 C9458 C9459 C9738 C9745–C9747 G0472 G0475 G0476 G0516–G0518 G6001–G6020 G6022–G6025 G6027 G6028 G9890 G9891 J0202 J0257 J0740 J0897 J1071 J1447 J2430 J2502 J2820 J3121 J3145 J3420 J3486 J8561 J8562 J8655

J9015 J9019 J9020 J9032 J9039 J9040 J9042 J9043 J9050 J9100 J9130 J9178 J9179 J9181 J9190 J9200 J9202 J9228 J9265 J9267 J9271 J9301 J9302 J9307 J9308 J9315 J9340 J9351 J9360 Q2050 S0148 S3722 X3920 X3922 X4100 X4102 X4300 X4301 X4500 X4501 X4530 X4540 X9514

X9516 X9526 X9528 X9530 X9532 X9534 X9536 X9538 X9540 X9542 Z4300–Z4315 Z5406 Z5900 Z5902 Z5904 Z5906 Z5908 Z5910 Z5912 Z5914 Z5916 Z5918 Z5920 Z5922 Z5924 Z5934 Z5936

CPT Codes

19294 20600 20605 20610 21820 31505 31510–31513 31515 31520 31525–31531 31535 31536 31540 31541 31545 31546 31560 31561 31570 31571 31575–31579 31600 31601 31610 31612–31615 31652–31654 31715 31717 31720 31725 31730 32400 32405 32420 32553 33010 33011 33202 33203 33206–33208 33210–33218 33220 33222–33226

33233–33238 33240 33241 33243 33244 33249 33282 33284 36002 36005 36010–36015 36100 36140 36147 36148 36160 36200 36215–36218 36245–36248 36260–36262 36299 36440 36450 36455 36460 36465 36466 36470 36471 36475 36476 36478 36479 36481 36482 36483 36511–36514 36516 36800 36810 36815 36818–36821

cal child ser 15


Authorized Codes in SCC SCG 02 (continued)

38232 38790 38792 40812 41006–41009 41015–41018 41105 41108 41110 41805 42100 42400 42405 42550 42600 42650 42660 42700 42720 42725 42800 42802 42804 42955 43180 43200–43202 43204 43205 43210 43215–43217 43219 43220 43226–43228 43231 43232 43240–43251 43255 43256 43258–43264 43267–43269 43271–43273 43450

43453 43456 43458 43460 44360 44361 44363 44365 44366 44369 44376–44382 44384–44386 44388–44392 44394 44401 44402 44404–44408 44500 45300 45303 45305 45307–45309 45315 45317 45320 45321 45327 45330–45335 45337 45338 45340–45342 45346 45347 45349 45350 45378–45382 45384–45386 45388–45393 45398 46601 46604 46606–46608

46610–46612 46614 46615 46900–46910 46916 46917 46922 46924 46930 47000 47001 47533 47534 47536–47544 47550 48100 48102 48400 49185 49400 49402 49411 49419 49421–49424 49435 49436 50200 50382 50384–50387 50389–50391 50395 50396 50551 50553 50555 50557 50561 50562 50570 50572 50574–50576 50580

50684 50686 50688 50690 50951 50953 50955 50957 50961 50970 50972 50974 50976 50980 51715 51720 52000 52001 52005 52007 52010 52310 53020 53200 54001 54505 54700 54800 55000 55100 55300 56820 56821 58575 60000 60100 60300 61020 61026 61050 61055 61645

61650 61651 62273 64400 64402 64405 64408 64410 64413 64415–64418 64420 64421 64425 64430 64435 64445–64450 64479 64480 64483 64484 64505 64508 64510 64517 64520 64530 64912 64913 70350 70355 75557 75561 75565 75894 75898 75900–75902 75956–75962

cal child ser 16


Authorized Codes in SCC SCG 02 (continued)

75964 75966 75968 75970 75978 76496–76498 77261–77263 77280 77285 77290 77295 77299–77301 77306 77307 77316–77318 77321 77331–77334 77336 77338 77370–77373 77385–77387 77399 77401 77402 77407 77412 77417 77423 77427 77431 77432 77435

77470 77499 77520 77522 77523 77525 77600 77610 77615 77750 77761–77763 77767 77768 77770–77772 77778 77789 77790 77799 78265 78266 78451 78452 78459 78473 78481 78483 78494 78496 78499 78580 78585–78588 78594

78599 78608 78811–78816 80180 81370–81383 81535 81536 81538 81540 81545 86352 86832 86833 87623–87625 87806 88120 88121 88177 88341 88344 88364 88366 88369 88373 88374 88377 89337 90772 90935 90937 90945 90947

91200 93260 93261 93355 93451–93464 93503 93505 93530–93533 93561–93568 93571 93572 93600 93602 93603 93609 93610 93612 93613 93615 93616 93618–93622 93644 93799 93895 94656 94657 94660 94662 94726–94729 94780 94781 94799

95805 95808 95810 95811 95990 95999 96150 96151 96153 96446 96900 96910 96912 96913 96920–96922 96999 97799 99184 99291 b 99292 b 99468 b 99469 b 99471 b 99472 b 99475–99480 b 99485 99486

cal child ser 17


Transplant Centers Transplant Centers are identified with unique SCG 03 to facilitate the Service Code Group 03 diagnosis and treatment of CCS clients. The Transplant Center SCG

includes all codes available in preceding physician SCG 01 and Special Care Centers SCG 02. In addition, SCG 03 contains codes for diagnostic studies relative to Transplant Center unique services as follows. Authorized Codes in Transplant Centers SCG 03

HCPCS Codes

C9286 G0452 J0485 X9518 X9520

X9522 X9524 Z5414 Z5416 Z5422 Z5424

Z5438 Z5446 Z5460 Z5499 Z5805 Z5806 e Z5807 Z5833–Z5835 j

CPT Codes

49418 80180 81265 81267 81268 81595

86832 86833 93451–93468 93563–93568

Communication Disorder Communication Disorder Centers are identified with unique SCG 04, Centers Service as follows, to facilitate the diagnosis and treatment of CCS clients. Code Group 04

Authorized Codes in Communication Disorder Centers SCG 04

HCPCS Codes

Q3014 T1014 V5008 V5010 V5014 V5264 V5267 X4300 X4301 X4303 X4304 X4500 X4501 X4504 X4520 X4522 X4526 X4530 X4532 X4540

X4542 X4544 Z0324 h Z0326 h Z0328 h Z0329 h Z4300 Z4302 Z4307 Z4311 Z4314 Z5406 Z5822 Z5900 Z5902 Z5904 Z5906 Z5908 Z5910 Z5912 Z5914 Z5916

Z5918 Z5920 Z5922 Z5924 Z5928 Z5930 Z5932 Z5934 Z5936 Z5940 Z5944 Z5956 Z7500 Z7502 Z7504 Z7506 Z7508 Z7510 Z7512 Z7514 Z7612

CPT Codes

81430 81431 92550–92553 92555–92557 92559–92565 92567 92568 92570–92572 92575–92577 92579 92582 92583 92585–92588 92590 92591 92594 92595 92620 92621 92625–92627 92630 92633

99201–99205 99211–99215 99241–99245 99354 99355

cal child ser 18


Cochlear Implant Cochlear Implant Centers are identified with unique SCG 05, as Centers Service follows, to facilitate the diagnosis and treatment of CCS clients. Code Group 05

Authorized Codes in Cochlear Implant Centers SCG 05

HCPCS Codes

L7510 L8615–L8618 L8621–L8624 L8629 L8693 L9900 Q3014 T1014 V5008 V5010 V5014 V5264 V5267 X4300 X4301 X4303 X4304 X4500 X4501 X4504

X4520 X4522 X4526 X4530 X4532 X4540 X4542 X4544 X9514 X9516 X9518 X9520 X9522 X9524 X9526 X9528 X9530 X9532 X9534 X9536 X9538 X9540 X9542

Z4300 Z4302 Z4307 Z4311 Z4314 Z5406 Z5822 Z5900 Z5902 Z5904 Z5906 Z5908 Z5910 Z5912 Z5914 Z5916 Z5918 Z5920 Z5922 Z5924 Z5928 Z5930 Z5932

Z5934 Z5936 Z5940 Z5942 Z5944 Z5950 Z5952 Z5954 Z5956 Z5958 Z5964 Z5966 Z5968 Z7500 Z7502 Z7504 Z7506 Z7508 Z7510 Z7512 Z7514 Z7612

CPT Codes

81430 81431 92510 92550–92553 92555–92557 92559–92565 92567 92568 92570–92572 92575–92577 92579 92582 92583 92585–92588 92590 92591 92594 92595 92601–92604 92620 92621 92625–92627 92630 92633 96110 96111 96117 99201–99205 99211–99215 99241–99245 99354 99355

cal child ser 19


High Risk Infant High Risk Infant Follow-Ups (HRIF) are identified with unique Follow-Up Service SCG 06, as follows, to facilitate the diagnosis of CCS clients. Code Group 06

Authorized Codes in High Risk Infant Follow-Up SCG 06

HCPCS Codes

Q3014 T1014 X4300 X4301 X4500 X4501 X4522 X4530 X4540

X9514 X9534 X9542 Z4300–Z4307 Z4309–Z4311 Z5406 Z5900 Z5902 Z5906 Z5908 Z5912 Z5914 Z5916 Z5918 Z5920

Z5922 Z5924 Z5934 Z5936 Z7500 Z7502 Z7504 Z7506 Z7508 Z7510 Z7512 Z7514 Z7610 Z7612

CPT Codes

92002 92004 92012 92014 92081–92083 92225 92226 92250 92499 92550–92553 92555–92557 92567

92568 92570–92572 92575–92577 92579 92582 92585–92588 96110 96111 h 96112 h 96113 h 99201–99205 99211–99215 99241–99245 99354 99355

cal child ser 20


Orthopedic Surgeon Orthopedic surgeons are identified with unique SCG 07 to facilitate the Service Code Group 07 diagnosis and treatment of CCS clients. The orthopedic surgeon SCG

includes all codes available in preceding physician SCG 01. In addition, SCG 07 contains codes for diagnostic studies relative to CCS-eligible orthopedic services as follows. Authorized Codes in Orthopedic Surgeon SCG 07

HCPCS Codes

G0428 G9914 J7326 J7328 Q4150–Q4159 Q4161–Q4165 Z4300

CPT Codes

11010–11012 20527 20600 20604–20606 20610 20611 20650 20670 20680 20690 20692–20694 20983 21811–21813 22510–22515 22633 22634 22858 23500 23505 23515 23520 23525 23530 23532 23540 23545 23550 23552 23570 23575 23585 23600 23605 23615 23616 23620 23625 23630 23650

23655 23660 23665 23670 23675 23680 23700 23800 23802 23900 23920 23921 23929–23931 23935 24000 24006 24065 24066 24071 24073 24075–24077 24079 24100–24102 24105 24110 24115 24116 24120 24125 24126 24130 24134 24136 24138 24140 24145 24147 24149 24150 24152 24155 24160 24164 24200

24201 24220 24300 24301 24305 24310 24320 24330–24332 24340–24346 24357–24363 24365 24366 24400 24410 24420 24430 24435 24470 24495 24498 24500 24505 24515 24516 24530 24535 24538 24545 24546 24560 24565 24566 24575–24577 24579 24582 24586 24587 24600 24605 24615 24620 24635 24640 24650

24655 24665 24666 24670 24675 24685 24800 24802 24900 24920 24925 24930 24931 24935 24940 24999–25001 25020 25023–25025 25028 25031 25035 25040 25065 25066 25071 25073 25075–25078 25085 25100 25101 25105 25107 25110–25112 25115 25116 25118–25120 25125 25126 25130 25135 25136 25145 25150 25151

cal child ser 21


Authorized Codes in Orthopedic Surgeon SCG 07 (continued)

25170 25210 25215 25230 25240 25246 25248 25250 25251 25259

25260 25263 25265 25270 25272 25274 25275 25280 25290 25295

25300 25301 25310 25312 25315 25316 25320 25332 25335 25337

25350 25355 25360 25365 25370 25375 25390–25394 25400 25405 25415

25420 25425 25426 25430 25431 25440–25447 25449 25450 25455

cal child ser 22



25490–25492 25500 25505 25515 25520 25525 25526 25530 25535 25545 25560 25565 25574 25575 25600 25605–25609 25622 25624 25628 25630 25635 25645 25650–25652 25660 25670 25671 25675 25676 25680 25685 25690 25695 25800 25805 25810 25820 25825 25830

25900 25905 25907 25909 25915 25920 25922 25924 25927 25929 25931 25999 26020 26025 26030 26034 26035 26037 26040 26045 26055 26060 26070 26075 26080 26100 26105 26110 26111 26113 26115 26117 26118 26121 26123 26125 26130 26135

26140 26145 26160 26170 26180 26185 26200 26205 26210 26215 26230 26235 26236 26250 26260 26262 26320 26340 26341 26350 26352 26356–26358 26370 26372 26373 26390 26392 26410 26412 26415 26416 26418 26420 26426 26428 26432–26434 26437 26440

26442 26445 26449 26450 26455 26460 26471 26474 26476–26480 26483 26485 26489 26490 26492 26494 26496–26500 26502 26508 26510 26516–26518 26520 26525 26530 26531 26535 26536 26540–26542 26545 26546 26548 26550 26551 26553–26556 26560–26562 26565 26567 26568 26580

26587 26590 26591 26593 26596 26600 26605 26607 26608 26615 26641 26645 26650 26665 26670 26675 26676 26685 26686 26700 26705 26706 26715 26720 26725 26727 26735 26740 26742 26746 26750 26755 26756 26765 26770

cal child ser 23

2 – California Children’s Services (CCS) Program Service Code Groupings July 2017


26775 26776 26785 26820 26841–26844 26850 26852 26860–26863 26910 26951 26952 26989–26992 27000 27001 27003 27005 27006 27025 27027 27030 27033 27035 27036 27040 27041 27043 27045 27047–27050 27052 27054 27057 27059 27060 27062 27065–27067 27070 27071 27075–27078 27080 27086 27087 27090 27091 27093

27095–27098 27100 27105 27110 27111 27120 27122 27125 27130 27132 27134 27137 27138 27140 27146 27147 27151 27156 27158 27161 27165 27170 27175–27179 27181 27185 27187 27193 27194 27200 27202 27215–27218 27220 27222 27226–27228 27230 27232 27235 27236 27238 27240 27244–27246 27248 27250 27252–27254

27256–27259 27265–27269 27275 27279 27280 27282 27284 27286 27290 27295 27299 27301 27303 27305–27307 27310 27323–27335 27337 27339 27340 27345 27347 27350 27355–27358 27360 27364 27365 27370 27372 27380 27381 27385 27386 27390–27397 27400 27403 27405 27407 27409 27412 27415 27416 27418 27420 27422

27424 27425 27427–27430 27435 27437 27438 27440–27443 27445–27448 27450 27454 27455 27457 27465 27466 27468 27470 27472 27475 27477 27479 27485–27488 27495–27503 27506–27511 27513 27514 27516 27517 27519 27520 27524 27530 27532 27535 27536 27538 27540 27550 27552 27556–27558 27560 27562 27566 27570 27580

27590–27592 27594 27596 27598–27607 27610 27612–27616 27618–27620 27625 27626 27630 27632 27634 27635 27637 27638 27640 27641 27645–27648 27650 27652 27654 27656 27658 27659 27664 27665 27675 27676 27680 27681 27685–27687 27690–27692 27695 27696 27698 27700 27702–27705 27707 27709 27712 27715 27720 27722 27724–27727

cal child ser 24



27730 27732 27734 27740 27742 27745 27750 27752 27756 27758–27760 27762 27767–27769 27780 27781 27784 27786 27788 27792 27808 27810 27814 27816 27818 27822–27832 27840 27842 27846 27848 27860 27870 27871 27880–27882 27884 27886 27888 27889 27892–27894 27899 28001–28003 28005

28008 28010 28011 28020 28022 28024 28035 28039 28041 28043 28045–28047 28050 28052 28054 28055 28060 28062 28070 28072 28080 28086 28088 28090 28092 28100 28102–28104 28106–28108 28110–28114 28116 28118–28120 28122 28124 28126 28130 28140 28150 28153 28160 28171 28173

28175 28190 28192 28193 28200 28202 28208 28210 28220 28222 28225 28226 28230 28232 28234 28238 28240 28250 28260–28262 28264 28270 28272 28280 28285 28286 28288–28290 28292–28294 28296–28300 28302 28304–28310 28312 28313 28315 28320 28322 28340 28341 28344 28345 28360

28400 28405 28406 28415 28420 28430 28435 28436 28445 28446 28450 28455 28456 28465 28470 28475 28476 28485 28490 28495 28496 28505 28510 28515 28525 28530 28531 28540 28545 28546 28555 28570 28575 28576 28585 28600 28605 28606 28615 28630

28635 28636 28645 28660 28665 28666 28675 28705 28715 28725 28730 28735 28737 28740 28750 28755 28760 28800 28805 28810 28820 28825 28899 29000 29010 29015 29035 29040 29044 29046 29086 29799 29904–29907 76881 76882 88361

cal child ser 25


RHC/FQHC Service Rural Health Clinic (RHC) and Federally Qualified Health Center Code Group 08 (FQHC) all-inclusive per visit codes comprise a unique SCG 08, as

follows, to facilitate the diagnosis and treatment of CCS clients. Authorized Codes in RHC/FQHC SCG 08

Per Visit Codes

01 02 03 04

HCPCS Codes

G0511–G0514

Chronic Dialysis Clinic Chronic Dialysis Clinics are identified with unique SCG 09 to facilitate Service Code Group 09 the diagnosis and treatment of CCS clients.

Authorized Codes in Chronic Dialysis Clinic SCG 09

HCPCS Codes

J0606 J0882 J0890 J1270 J1756 J2501 J2997 Q0139 Q4081

Z6000 Z6002 Z6004 Z6006 Z6008 Z6010 Z6012 Z6014 Z6016 Z6018 Z6020 Z6022

Z6024 Z6026 Z6028 Z6030 Z6032 Z6034 Z6036 Z6038 Z6040 Z6042

CPT Codes

90935 90937 90945 90947 90951–90970 90989 90993 96360 96361 96365–96375 96379 99070

cal child ser 26


Ophthalmology Ophthalmologists are identified with unique SCG 10 to facilitate Service Code Group 10 the diagnosis and treatment of CCS clients.

Authorized Codes in Ophthalmology SCG 10

HCPCS Codes

C1840 C9732 J7313 Q3014 T1014

CPT Codes

11900 15820–15823 21256 21260 21261 21263 21267 21268 21280 21282 21390 30930 61330 61332 61333 65091 65093 65101 65103 65105 65110 65112 65114 65125 65130 65135 65140 65150 65155 65175 65235 65260 65265 65270 65272 65273 65275 65280

65285 65286 65290 65400 65410 65420 65426 65436 65450 65600 65710 65730 65750 65755–65757 65770 65778–65782 65785 65810 65815 65820 65850 65855 65860 65865 65870 65875 65880 65900 65920 65930 66020 66030 66130 66150 66155 66160 66170 66172 66174 66175 66179

66180 66184 66185 66220 66225 66250 66500 66505 66600 66605 66625 66630 66635 66680 66682 66700 66710 66711 66720 66740 66761 66762 66770 66820 66821 66825 66830 66840 66850 66852 66920 66930 66940 66982–66986 66990 66999 67005 67010 67015 67025 67027

67028 67030 67031 67036 67039–67043 67105 67107 67108 67110 67113 67115 67120 67121 67141 67145 67208 67210 67218 67220 67221 67225 67227–67229 67250 67255 67299 67311 67312 67314 67316 67318 67320 67331 67332 67334 67335 67340 67343

cal child ser 27


Authorized Codes in Ophthalmology SCG 10 (continued)

67345 67346 67350 67399 67400 67405 67412–67415 67420 67430 67440 67445 67450 67505 67550 67560 67570 67599 67808

67825 67830 67835 67875 67880 67882 67900–67904 67906 67908 67909 67911 67912 67914–67917 67921–67924 67950 67961 67966 67971

67973–67975 67999 68115 68130 68135 68320 68325 68326 68328 68330 68335 68340 68360 68362 68371 68400 68420 68440

68500 68505 68510 68520 68525 68530 68540 68550 68700 68705 68720 68745 68750 68760 68761 68770 68811 68815

68816 68850 68899 69990 92025 92071 92072 92132–92134 92145 92227 92228 92499 99177

cal child ser 28


Medical Therapy Physical and occupational therapists are identified with unique Service Code Group 11 SCG 11 to facilitate the diagnosis and treatment of CCS clients.

Authorized Codes in Medical Therapy SCG 11

HCPCS Codes

Q3014 T1014 X3900 X3902 X3904 X3906 X3908 X3910

X3912 X3914 X3916 X3918 X3920 X3922 X3926 X3928 X3930 X3936

X4100 X4102 X4104 X4106 X4110 X4112 X4118 X4120 Z0324 h Z0326 h

Z0328 h Z0329 h

CPT Codes

99201–99205 99211–99215 99241–99245 99354 99355

Podiatry Service Podiatrists are identified with unique SCG 12 to facilitate the diagnosis Code Group 12 and treatment of CCS clients.

Authorized Codes in Podiatry SCG 12

HCPCS Codes

A4217 C9250 C9279 C9363 J0190 J0207 J0278 J0285 J0287–J0290 J0380 J0456 J0460 g J0461 J0475 J0520 J0558 J0561 J0595 J0600 J0630 J0670

J0690 J0696 J0710 J0720 J0725 J0740 J0745 J0760 J0800 J1094 J1100 J1170 J1364 J1580 J1610 J1642 J1644 J1720 J1840 J1850 J1940 J2001 J2010

J2175 J2300 J2310 J2400 J2515 J2545 J2550 J2560 J2700 J3010 J3260 J3301 J3303 J3370 J3410 J3475 J7030 J7040 J7042 J7050 J7060 J7070 J7120 L2861

P9010–P9012 P9016 P9017 P9019–P9023 P9031–P9041 P9043–P9048 P9050–P9060 Q3014 Q4100–Q4108 Q4110–Q4121 T1014 S0020 S0077 S0080 S2117 X3900 X3902 X3904 X5676 X5854 X5856

X6042 X6408

cal child ser 29


Authorized Codes in Podiatry SCG 12 (continued)

X6444 X6462 X6464 X6470 X6494 X6496 X7025 X7026 X9922 X9924 X9926 X9928 X9930 X9936 X9938 X9940 X9946 X9948 X9950 Z0324 h Z0326 h Z0328 h Z0329 h Z7500 Z7502 Z7504 Z7506 Z7508 Z7510 Z7512 Z7514 Z7610 Z7612

CPT Codes

10060 10061 10120 10121 10140 10160 10180 11000 11010–11012 11042–11044 11045–11047 11055–11057 11100 11101 11200 11420–11424 11426 11620–11624 11626 11720 11721 11730 11732 11740 11750 11752 11755 11760 11762 11765 11900 11901 11960 11981–11983 12001 12002 12004 12005 12041 12042 12044

12045 13131–13133 13160 14040 15050 15100 15115 15116 15565 15851 16000 16020 16035 17000 17003 17004 17106–17108 17110 17111 17270–17274 17276 17999 20005 20103 20200 20205 20500 20501 20520 20525 20550–20553 20600 20605 20606 20650 20670 20680 20838 27605–27607 27610 27612–27616 27618–27620 27625 27626

27630 27632 27634 27647 27648 27650 27652 27654 27658 27659 27664 27665 27675 27676 27680 27681 27685–27687 27690–27692 27695 27696 27698 27700 27702–27704 27760 27762 27766–27769 27786 27788 27792 27808 27810 27814 27816 27818 27822–27829 27840 27842 27846 27848 27860 27870 27899 28001–28003

28005 28008 28010 28011 28020 28022 28024 28035 28039 28041 28043 28045–28047 28050 28052 28054 28055 28060 28062 28070 28072 28080 28086 28088 28090 28092 28100 28104 28108 28110–28114 28116 28118–28120 28122 28124 28126 28130 28140 28150 28153 28160 28171 28173 28175

cal child ser 30


Authorized Codes in Podiatry SCG 12 (continued) 28190 28192 28193 28200 28202 28208 28210 28220 28222 28225 28226 28230 28232 28234 28238 28240 28250 28260–28262 28264 28270 28272 28280 28285 28286 28288–28290 28292–28294 28296–28300 28302 28304 28306–28310 28312 28313 28315 28320 28322 28340 28341 28344 28345 28360 28400 28405 28406 28415 28430 28435 28436 28445

28446 28450 28455 28456 28465 28470 28475 28476 28485 28490 28495 28496 28505 28510 28515 28525 28530 28540 28545 28546 28555 28570 28575 28585 28600 28605 28606 28615 28630 28635 28645 28660 28665 28675 28705 28715 28725 28730 28735 28737 28740 28750 28755 28760 28800 28805 28810 28820

28825 28890 28899 29345 29355 29358 29365 29405 29425 29435 29440 29445 29450 29505 29515 29540 29550 29580 29581 29700 29705 29730 29740 29750 29799 29891–29894 29904–29907 37799 64450 64455 64632 64702 64704 64726 64782 64783 64831 64832 64834 64837 73590 73600 73610 73615 73620 73630 73650 73660

76000 76140 76499 76999 80047 80048 80051 80053 81000–81003 82310 82374 82435 82565 82800 82803 82805 82810 82947 82948 84132 84295 84520 84525 85002 85004 85007 85013 85014 85018 85025 85027 85044 85045 85170 85175 85300–85303 85305–85307 85335 85345 85347 85396 85397 85520 85576 85610 85611 85651 85652

85660 85670 85675 85730 85732 85810 85999 86038 86039 86060 86063 86077–86079 86140 86141 86162 86235 86430 86431 86590 86900 86901 86904–86906 86945 87040 87070 87071 87073 87075–87077 87081 87084 87086 87088 87101–87103 87106 87205–87207 87210 87220 87250 87252–87255 87640 87641 87653 87906 88104 88106–88108 88112 88300

cal child ser 31


Authorized Codes in Podiatry SCG 12 (continued)

88302 88304 88305 88307 88309 88311–88314 88319 88321 88323 88325 88329 88331–88334 88342 88346 88348

88355 88356 88358 88360–88362 88367 88368 88371 88372 88380 88381 88387 88388 88399 89050 89051

90471 93799 93925 93926 95831 95851 97010 97012 97014 97016 97018 97022 97024 97026 97028

97032–97036 97039 97110 97112 97113 97116 97124 97139 97140 97597 97598 97810 97811 97813 97814

99000 99070 99201–99203 99211–99213 99221 99223 99231 99232 99241–99243 99251–99253 99281–99284 99341–99345 99347–99350

cal child ser 32


EXCLUDE SERVICE CODE GROUPS Physician Service SCG 51 is authorized by CCS to a physician for the provision of Code Group 51 surgical services to a CCS client. For more information on SCG 51,

see CCS Numbered Letter 02-0510 at www.dhcs.ca.gov/services/ccs/Documents/ccsnl020510.pdf.

HCPCS Codes

C9270 J0585–J0587 J1459 J1559 J1561 J1562 J1566 J1568 J1569 J1572 J1599 J1675 J1950 J7183 J7185–J7187 J7189 J7190 J7192–J7195 J7197 J7198 J9217 J9226 L8607 Q2040 S2055 S2065

X7034 X7036 X7108 X7452 X7454 X7494 Z0312 Z7304 Z7306 Z7308 Z7312 Z7314 Z7316 Z7320 Z7322

CPT Codes

15730 15733 19294 31241 31253 31257 31259 31298 32851–32854 32994 33250 33251 33261 33927–33929 33935 33945 34701–34716 36465 36466 36482 36483 36822 38204–38215 38230 38240–38242 38573 39401 39402 43286–43288 43644 43645 43770–43774 43842 43843 43845–43848 43886–43888

44135 47135 47140–47142 47535 50320 50340 50360 50365 50380 50432–50435 50606 50693–50695 50705 50706 54400 54406 54408 54410 54411 54415–54417 54437 54438 58575 59000 59001 59012 59015 59020 59025 59030 59050 59051 59070 59072 59074 59076 59100 59120 59121 59130 59135 59136 59140 59150 59151 59160

59300 59320 59325 59350 59400 59409 59414 59510 59514 59525 59610 59612 59618 59620 59812 59820 59821 59830 59840 59841 59850 59852 59855–59857 59870 59871 59897–59899 61885 61886 62360–62362 64553 64573 64912 64913 69930 90378 93623 93624 93631 93640–93642 93650–93652 95115 95180 95199 95873 95874

www.dhcs.ca.gov/services/ccs/Documents/ccsnl020510.pdf