Get the free Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions - cdph ca

This document provides instructions and information for pharmacies on how to submit claims for extemporaneously compounded prescriptions under the Medi-Cal program, including necessary forms, codes,

How to fill out medi-cal reimbursement schedule for

How to fill out Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions

1. Obtain the Medi-Cal Reimbursement Schedule form for Extemporaneously Compounded Prescriptions.
2. Fill in the patient's information including name, identification number, and date of service at the top of the form.
3. Document the prescription details such as the drug name, dosage, quantity dispensed, and compounding instructions.
4. Include the NDC (National Drug Code) for each ingredient used in the compounded prescription.
5. Itemize the costs associated with each ingredient and the professional fee for compounding.
6. Calculate the total reimbursement amount requested and ensure it aligns with Medi-Cal guidelines.
7. Sign and date the form as the provider or authorized representative.
8. Submit the completed form to the appropriate Medi-Cal processing address.

Who needs Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

1. Pharmacists who provide extemporaneously compounded prescriptions to Medi-Cal patients.
2. Healthcare providers seeking reimbursement for compounded prescriptions under the Medi-Cal program.
3. Patients receiving compounded medications that are covered by Medi-Cal.

People Also Ask about

Does Medi-Cal reimburse for prescriptions?

Medi-Cal is California's Medicaid program. It usually comes with extensive prescription drug coverage. Depending on your situation, this coverage can be free, cost a small premium, or require that you spend a certain amount of your own money before coverage begins.

How much is J7354 reimbursement?

YCANTH, an office-administered medication with HCPCS code J7354, has an Average Sales Price (ASP) of $643.64 as of April 2025. Medicare reimburses providers based on the Medicare Payment Limit of $682.26, though after sequestration, the actual payment (ASP +4.3%) comes out to $671.32.

Does Medi-Cal cover compounded medications?

Note: Products that are "Covered for compounds" are payable without a prior authorization (PA) when billed as part of a compound drug claim. Drugs that require a PA and also are assigned a Code 1 restriction may be covered without a PA for a specific brand name. Please refer to the CDL.

How much does Medi-Cal reimburse for therapy?

The Medi-Cal "Look-Back" period in California is 30 months. "Transfer" means an outright gift or a "sale" made at less than "fair market value." If a disqualifying transfer of property is made, Medi-Cal will calculate the period of ineligibility for nursing facility level of care.

Can you get reimbursed from Medi-Cal?

To get a refund for payments made after you received your Medi-Cal card, you must have paid a provider who accepts Medi-Cal. How Do I File a Claim? To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement.

How much does Medi-Cal reimburse?

Currently, Medi-Cal's reimbursement for primary care and non-specialty mental health services is anywhere from 70% to 100% of what Medicare pays, ing to the state's Department of Health Care Services. For instance, in San Francisco, Medicare pays about $108 for a basic doctor's office visit.

What is the 3 month rule for Medi-Cal?

Processing your application can take several weeks because Medi-Cal must first determine eligibility by verifying your income and personal assets before coverage can be approved. You may request Medi-Cal to pay retroactively for the three months prior to the month in which you apply.

For pdfFiller’s FAQs

What is Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

The Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions outlines the guidelines and reimbursements available for compounded medications reimbursed under the Medi-Cal program, ensuring that pharmacies are compensated for the preparation of custom compounds.

Who is required to file Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

Pharmacies and healthcare providers that prepare and dispense extemporaneously compounded prescriptions for Medi-Cal beneficiaries are required to file the Medi-Cal Reimbursement Schedule to receive appropriate reimbursements.

How to fill out Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

To fill out the Medi-Cal Reimbursement Schedule, pharmacies must provide detailed information about the compounded prescription, including the drug name, quantity, prescription number, ingredient costs, and any applicable billing codes as outlined by the Medi-Cal guidelines.

What is the purpose of Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

The purpose of the Medi-Cal Reimbursement Schedule is to establish a systematic approach for pharmacies to receive compensation for the preparation of compounded prescriptions, ensuring proper reimbursement for the costs incurred in providing these specialized medications.

What information must be reported on Medi-Cal Reimbursement Schedule for Extemporaneously Compounded Prescriptions?

The information that must be reported includes the pharmacy's details, prescription number, drug name, NDC (National Drug Code), quantity dispensed, ingredient costs, billing codes, and any other required documentation as specified by Medi-Cal.