Rates: Maximum Reimbursement for Outpatient Room Rates ...



This section describes the maximum reimbursement for hospital outpatient departments. For additional information, refer to the Rates: Maximum Reimbursement section in this manual.

Hospital Outpatient Rates for emergency, examining, treatment rooms and related

Departments and charges are shown below (reference: California Code of Regulations

Organized Outpatient (CCR), Title 22, Sections 51509 and 51509.1). These procedure

Surgical Facilities codes are not reimbursable to community clinics, free clinics,

county-operated organized outpatient clinics, Rural Health Clinics and other organized outpatient clinics unless the clinics are enrolled in the Medi-Cal program as an organized outpatient clinic with surgical facilities, as defined in CCR, Title 22, Section 51115(b).

Maximum Rates

Organized

Hospital Outpatient Clinics

HCPCS Outpatient With Surgical

Code Description Departments Facilities

Z7500 Use of hospital examining or treatment room $ 23.77 $ 21.66

Z7502 * Use of emergency room 34.58 –

Z7504 Use of cast room 34.58 31.49

Z7506 Use of operating room or cystoscopic room

first hour 101.90 92.83

Z7508 first subsequent half hour 40.76 37.13

Z7510 second subsequent half hour 40.76 37.13

– maximum reimbursement 224.19 185.65

Z7512 Use of recovery room 18.22 16.59

Z7514 Room and board, general nursing

care for stays of less than 24 hours,

including ordinary medication 40.76 37.13

Z7612 Unlisted services By Report By Report

Z7614 Hoptel services/room/board per day 32.53 –

* Reimbursable only for treatment of emergency conditions; for non-emergency conditions, bill with examining room HCPCS code Z7500.

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