Initial Combined Assessment (ICA) - Department of Public Health

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8ProcedureCodeDescription When to Use MaximumUnits ofServiceAssessment, Treatment, and/orgroup class.Intervention, Group, per patient, each 15minutes(Maximum of 2 hours)Reimbursementper Unit of ServiceMaximumReimbursement 1Z6414Postpartum Health EducationAssessment, Treatment, and/orIntervention, including update of CarePlan, Individual, each 15 minutes(Maximum of 1 hour)1) Postpartum health educationassessment;2) Postpartum health educationintervention.4 $8.41 $33.64PERINATAL EDUCATION CODES(Can be used antepartum or postpartum)Z6410 Perinatal Education, Individual, each 15minutes (Maximum of 4 hours)Individual education providedprenatally or postpartum.16 $8.41 $134.56Z6412Perinatal Education, Group, per patient,each 15 minutes (Maximum 4hours/day,18 hours/pregnancy)Group education, e.g. childbirtheducation (Lamaze)72 $2.81 $202.32CPSP OB BONUSESZ1032-ZLInitial Comprehensive Pregnancy-relatedoffice visit performed within 16 weeks ofLMPInitial prenatal exam done prior to17 weeks LMP. If non-physicianpractitioner (NP, PA, CNM) doesexam, see M/C Provider Manual forappropriate modifier.1 $56.63 $56.63Z1036 Tenth Antepartum Office Visit One time only when 10 thantepartum visit performed.1 $113.26 $113.261 Additional reimbursement is subject to prior approval using a Medi-Cal Treatment Authorization Request (TAR).2 If Z6500 is used, codes Z6200, Z6300, and Z6402 cannot be used because the first 30 minutes of each assessment is alreadyincluded in Z6500.However, additional initial assessment time can be billed under codes Z6202, Z6302, or Z6404.3 Entry into care is the time of the first billable pregnancy-related office visit or initial support service assessment.Rev. 12/18/09
LOS ANGELES COUNTY DEPARTMENT OF PUBLIC HEALTH 9COMPREHENSIVE PERINATAL SERVICES PROGRAM600 S. Commonwealth Ave., Suite 800Los Angeles, CA 90005(213) 639-6419 FAX (213) 639-1034Joanne Roberts, PHNHarold Sterker, M.P.H., C.H.E.S.Perinatal Services CoordinatorHealth Education Consultant(213) 639-6427 (213) 248-1159 CellE-mail address: jroberts@ph.lacounty.govE-mail address: hsterker@ph.lacounty.govOtilia Elszy, PHNChristian Murillo, B.S.Assistant CoordinatorHealth Education AssistantSouth LA, Southeast LA Co.(213) 639-6422 Office(213) 639-6428 (323) 246-5487 CellE-mail address: otelszy@ph.lacounty.govE-mail address: cmurillo@ph.lacounty.govI. Jean Floyd, PHN Bertha SolisAssistant CoordinatorStaff SupportNorth LA, Co., San Gabriel Valley (213) 639-6445(213) 639-6429 E-mail address: bsolis@ph.lacounty.govE-mail address: ifloyd@ph.lacounty.govCarol Phillips, PHNAssistant CoordinatorSouthwest LA. Co., So. Bay, Downtown LA(213) 639-6426E-mail address: cphillips@ph.lacounty.govCity of Long BeachDept. of Health & Human ServicesJenny Morales, PHNKaren Prochnow, PHNAssistant CoordinatorPerinatal Services CoordinatorHollywood, SF Valley, Antelope Valley2525 Grand Avenue(213) 639-6437 Long Beach, CA90815E-mail address: jmorales@ph.lacounty.gov(562) 570-4209 (phone)(562) 570-4099 (fax)karen-prochnow@longbeach.govThelma B. Hayes, M.A., R.D., CLENutrition Consultant(213) 639-6423E-mail address: thayes@ph.lacounty.govPasadena City Health Dept.Geraldine Perry-Williams, PHNPerinatal Service Coordinator1845 N. Fair Oaks Ave. 2 nd FloorPaula Binner, L.C.S.W.Clinical Social Work Consultant Pasadena, CA 91103(213) 639-6424 (626) 744-6092 (phone)E-mail address: pbinner@ph.lacounty.gov(626) 744- 6112 (fax)gperry-williams@cityofpasaden.netCPSP Web Site Address: www.publichealth.lacounty.govMy/doc: Staff roster12.docRevised, December 14, 2009
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Initial Combined Assessment (ICA) - Department of Public Health

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