Referral providers are those who receive referrals from EWC PCPs to render any screening or diagnostic services. Referral providers must be Medi-Cal providers in good standing and licensed in the State of California. Referral providers do not enroll in EWC or sign a provider agreement. Referral providers include:
What services are covered by EWC?
Breast Cancer Screening and Diagnostic Services include:
Clinical breast exam (CBE) and follow-up exams of abnormal findings as needed.
Each PCP can order one screening mammogram per year for women age 40 and older.
Abnormal CBE/Mammogram Results
When a CBE or screening mammogram is abnormal, a diagnostic mammogram work–up should be initiated, which may include a diagnostic mammogram and/or other diagnostic procedures.
Screening Mammogram A diagnostic mammogram and/or other diagnostic procedures should be ordered with an abnormal CBE or screening mammogram. Individuals of any age and gender with symptoms suggestive of breast cancer may qualify for EWC.
Other Diagnostic Services
Additional breast diagnostic services include: ultrasound, fine needle aspiration (FNA), core needle and/or excisional biopsies, which are reimbursable until a final diagnosis is made. Cancer treatment is not covered by EWC. The individual can be referred to the Breast and Cervical Treatment Program (BCCTP) for assistance with cancer treatment costs. For more information about the BCCTP, visit their website.
For a diagnosis of breast cancer, cervical cancer, or high grade cervical lesions, EWC's PCPs can enroll EWC recipients into the Breast and Cervical Cancer Treatment Program (BCCTP). BCCTP enrollment is available online at www.medi-cal.ca.gov. For more information, call 1 (800) 824-0088.
Pelvic exam and Pap Smear
A colposcopy and up to four biopsies, Endocervical Curettage (ECC) billed as biopsy, are reimbursable when either a Pap Smear or the visual inspection of the cervix is abnormal
Diagnostic services are covered until final pathology diagnosis is made.
Where should I send my EWC patients for mammograms?
Primary Care Providers can refer patients to any radiology facility that is a Medi-Cal provider in good standing and licensed in the State of California. These Referral Providers do not enroll patients into EWC or sign a provider agreement.
I need help with billing.
Claims for EWC services provided can be submitted either hard copy or electronically using the CMS-1500 or UB-04. Providers who choose to submit hard copy claims must send them to the appropriate address for their claim type, as follows:
Medi-Cal Services (CMS-1500)
Outpatient Services (UB-04)
Conduent P.O. Box 15700
Sacramento, CA 95852-1799
Conduent P.O. Box 15600
Sacramento, CA 95852-1600
For questions about EWC claims or claims procedures, call the Billing Support: 1-800-541-5555.
Where can I get more information for Primary Care Providers?
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