Medical Service Providers
The Victim Compensation Program may pay for medical and medically related expenses that are caused by a crime, including but not limited to:
- Medical services including hospitalization, surgery, ambulance transportation, and prescriptions.
- Medically necessary items such as eyeglasses, hearing aids, dentures and prosthetic devices that are lost, stolen, or broken during the crime or that become necessary due to the crime.
- Certain alternative medical treatments (physician referral and session limits apply).
- Patient's name and address
- Date(s) of service
- Type(s) of service(s) provided (ICD-10 and CPT codes)
- Billed amount
- Provider's license number, federal tax identification number (FEIN or SSN), business address, telephone number, signature or signature stamp, and billing date
CalVCB will transition to the International Classification of Diseases (ICD) 10 codes for inpatient services and medical diagnoses on October 1, 2015. The ICD is used to standardize codes for medical conditions, diagnoses, and institutional procedures. This change is concurrent with the Centers for Medicare and Medicare Services (CMS) transition from the ICD-9 to ICD-10 codes.
Please note, there are no changes to the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes used for outpatient, ambulatory, and office-based procedure coding.
To ease the transition, CalVCB will accept both the ICD-9 and ICD-10 codes until December 31, 2015. Effective January 1, 2016, bills not containing the ICD-10 codes will be returned. For more information about converting ICD-9 to ICD-10 codes, visit the American Academy of Professional Coders website or the CMS website.
Rates for Medical and Medical Related Services are:
- Medicare rate for services covered by Medicare
- 75% of the billed amount for services not covered by Medicare
- Durable Medical Equipment (DME) is paid at the Medicare rate, except for prosthetics, hearing aids and eyeglasses (see below).
- 80% of the billed amount for:
- Cosmetic surgery (Surgeon Fee only)- Facility and Anesthesia fees are subject to reduction by BRS
- Hearing aids and eyeglasses
- Foreign bills