|
|
RESTRICT
Restrict Services Code. This three-digit numeric code identifies a restriction or limitation on a recipient’s case. The information can be updated by the counties or the state.
1st and 2nd digits = Restricted Service Status 3rd digit of ‘1’ = County Limited Inquiry Access
1st and 2nd digits of ‘0’ with 3rd digit greater than ‘1’ = Minor Consent
|
Inquiry Limitations |
|
|
000 |
Restriction or limited inquiry access removed |
|
001 |
County confidential case - limited inquiry access |
|
Minor Consent Services |
|
|
004 |
Sexually transmitted diseases |
|
005 (7P) |
Outpatient mental health. |
|
006 (7R) |
Sexual assault |
|
007 (7M) |
Drug and/or alcohol abuse |
|
008 (7N) |
Pregnancy and family planning |
|
Service Restrictions |
|
|
010/011 |
Prior authorization required for drugs |
|
050/051 |
Prior authorization required for scheduled drugs |
|
110/111 |
Prior authorization required for M.D. visits |
|
120/121 |
Prior authorization required for M.D. visits and drugs |
|
140/141 |
Prior authorization required for all services except emergencies |
|
150/151 |
Restricted to primary M.D. and prior authorization required for drugs |
|
200/201 |
Prior authorization required for dental visits |
|
210/211 |
Prior authorization required for dental visits and drugs |
|
220/221 |
Prior authorization required for physician visits and dental visits |
|
230/231 |
Prior authorization required for physician visits, dental visits, and drugs |
|
240/241 |
Recipient is restricted to primary physician with prior authorization required for drugs and dental visits |
|
600/601 |
For claims payment, BIC ID number and issue date required |
|
900/901 |
Hospice services only |
|
910/911 |
Hospice services overlaid previous S/URS restriction |
|
920/921 |
Hospice services posted retroactively |
|
930/931 |
Hospice services retroactively overlaid previous S/URS restriction |
|
950/951 |
LTC restriction due to transfer of assets |
|
960/961 |
LTC restriction overlaid previous S/URS restriction |
|
970/971 |
Medi-Cal Ineligible due to non-cooperation in medical support enforcement |
|
980/981 |
Medi-Cal ineligible due to non-cooperation in medical support enforcement overlaid previous S/URS restriction |