Service Restrictions for Medi-Cal Abuse/Codes and Messages

Service Restrictions for Medi-Cal Abuse/Codes and Messages

DHCS enters restriction messages in the CA-EV/CMS when a client is found abusing MC services. Therefore, when the provider verifies eligibility through the POS network, the following are examples of messages/codes that may be seen:

Service Restrictions for MC Abuse/Codes and Messages

Message

Description

Restriction Codes*

“TAR Required For Drugs”
  • An approved “Treatment Authorization Request” (TAR) is required from a MC field office drug unit for all.
  • Non-emergency prescription drugs for a client found misusing drugs supplied through MC.

Code on MEDS: 010

“TAR Required For Scheduled Drugs”

An approved TAR is required from a MC field office drug unit for all non-emergency prescription for a client found misusing scheduled drugs supplied through MC.

Code on MEDS: 050

“TAR Required For Physician Visits”

An approved TAR is required for non- emergency outpatient physician visits for a client found utilizing an excessive number of outpatient physician visits.

Code on MEDS: 110

“TAR Required for Physician Visits and Drugs”

An approved TAR is required for non-emergency outpatient visits and non-emergency prescription drugs for a client found abusing both outpatient physician visits and scheduled drugs.

Code on MEDS: 120

NOTE: Restriction codes on MEDS may be seen on the [INQM] Screen, [RESTRICT] Field.

Note: Refer the client to his/her provider to request a “Treatment Authorization Request” (TAR).

Related Topics

Determining Usage