DMC State Billing Playbook
The Drug Medi-Cal State Plan (DMC-State Plan) Playbook is a collection of all requirements and guidelines from the DMC-State Plan Billing Manual. Included are myAvatar specific recommendations for system configuration to comply with the CalAIM requirements.
The Playbook also contains Cal-PM and MSO enhancement information.
The Playbook is divided into sections corresponding to the Billing Manual.
Playbook sections
| Section | Description/Notes |
|---|---|
| Client Eligibility | Chapter 3 of Billing Manual - This section details Medi-Cal Eligibility and Aid Codes. |
| Covered Services | Chapter 4 of Billing Manual - This section details DMC- State Plan Covered Services and Levels of Care. |
| DMC-SP Claim Processing | Chapter 5 of Billing Manual - This section relates to the SD/MC Claiming Process. |
| Cal-PM and MSO Enhancements | This section give information on Cal-PM and MSO Enhancements |
| Funding | Chapter 6 of Billing Manual - This section provides information on the funding relationship between Federal Share, State share and Proposition 30, and the County Share. |
| Disciplines | Table 1 in Billing Manual - These abbreviations of Disciplines are used in the Service Code lists. |
| Place of Service Codes | Table 2 in Billing Manual - These are the Place of Service Codes used with Service Codes. |
| Modifiers | Table 3 in Billing Manual - These are the Modifiers that are attached to Service Codes. |
| Taxonomy Codes | Appendix 1 - A list of First Four Alpha-numeric Characters of Taxonomy codes. |
| Definitions | Appendix 2 - A list of common terms in the Billing manual. |
| DMC Procedure Code | Appendix 3 - A list of Procedure codes included as benefits for DMC-State Plan counties. |
Service Codes List
- Assessment Codes
- SUD Crisis Intervention Codes
- Medication Services Codes
- Mobile Crisis Codes
- Treatment Planning Codes
- Individual Counseling Codes
- Group Counseling Codes
- Supplemental Service Codes
- Discharge Services Codes
- Peer Support Specialist Codes