The Alliance has made a rate adjustment for procedures 81513 and 81514. The Department of Health Care Services (DHCS) revised the Medi-Cal rates for these procedures, updating the rate from $114.10 to $86.72. This change is effective retroactively for dates of service on or after April 15, 2025.
What this means for your claims
The Alliance updated its internal payment system with the new rates on July 18, 2025. Any claims for procedures 81513 and 81514 with dates of service on or after April 15, 2025, that were previously reimbursed at the higher rate will be automatically adjusted to reflect the revised Medi-Cal rate.
What do providers need to do?
No action is required on your part. Adjusted claims will appear on future Remittance Advice (RA) statements with the applicable adjustment details.
If you disagree with any of these adjustments, you may submit a Provider Inquiry Form. For guidance on completing the form, please refer to the Provider Dispute Resolution section of the Alliance Provider Manual.
Questions?
If you have questions regarding these adjustments, please contact the Alliance Claims Department at 800-700-3874, ext. 5503.
