California Code of Regulations
Title 22 - Social Security
Division 3 - Health Care Services
Subdivision 1 - California Medical Assistance Program
Chapter 3 - Health Care Services
Article 4 - Scope and Duration of Benefits
Section 51316 - Respiratory Care Services
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Respiratory care services provided by respiratory care practitioners acting within their scope of practice, upon the written prescription of a physician or surgeon, are covered as Medi-Cal benefits subject to the following:
(b) Reimbursement will not be made for:
(c) Except as otherwise noted, respiratory care services are subject to prior authorization.
(d) One respiratory care evaluation (code number X4700) of a patient with an acute respiratory illness, or respiratory problem in a six (6) month period, is covered without prior authorization unless reimbursement for a comparable examination has been made to the patient's physician within six months. Additional evaluations within a six (6) month period require medical justification and are subject to prior authorization. A respiratory care evaluation or reevaluation includes but is not limited to:
(e) Participation in an organized respiratory care case conference (code number X4702) with other health team members immediately involved in the care or recovery of the patient is reimbursable only when the following criteria are met:
1. New section filed 6-23-97; operative 7-23-97 (Register 97, No. 26).
Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Sections 14509 and 14132, Welfare and Institutions Code.