Medi-Cal Rates Conversion Factors
Medi-Cal Rates as of 11/15/2021

Medi-Cal Rates are updated and effective as of the 15th of the month and published to the Medi-Cal website on the 16th of the month

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[Code Range Contents]

Conversion Indicators and Conversion Factors Used to Calculate Maximum Rates (Medi-Cal Rates as of 11/15/2021)

Conversion Indicators on Rate Worksheet Physician,Hospital Outpatient Dept,etc.(Provider Type=05, 07, 15, 22, 26, 28, 56, 61) Place of Service=Emergency Room (If ER Indicator="1") Free,Community & County Clinic (P/T=40, 41, 48, 58) Other Clinic (P/T=42, 43, 44, 45, 46, 50) Podiatrist (P/T=27) Nurse Anesthetist (P/T=18)
Conv IndPatient AgeService TypeConv IndConv FactorConv IndConv FactorConv IndConv FactorConv IndConv FactorConv IndConv FactorConv IndConv Factor
001ADULTPRIMARY CARE I 001 $10.00056 $12.42011 $12.38022 $10.59-- -- -- --
001CHILDPRIMARY CARE I 045 $10.91056 $12.42043 $13.59044 $11.50-- -- -- --
002ALL ANESTHESIOLOGY 002 $14.01-- -- 028 $14.71028 $14.71-- -- 013 $11.02
003ALL OB (C-SECTION) 003 $82.16-- -- 024 $86.29024 $86.29-- -- -- --
004ALL OTHER SURGERY 004 $37.23018 $46.95025 $39.10025 $39.10-- -- 004 $37.23
004ALL SURGERY (LAPAROSCOPY GYN) 016 $50.67-- -- 027 $53.22027 $53.22-- -- -- --
005ALL RADIOLOGY 005 $3.82-- -- 029 $4.00029 $4.00-- -- -- --
006ALL PATHOLOGY 006 $0.76-- -- 006 $0.76006 $0.76-- -- -- --
007ALL MEDICINE 007 $0.82017 $1.04012 $1.07023 $0.85-- -- -- --
008ALL REVIEW (MANUAL PRICING) 008BY REPORT008BY REPORT008BY REPORT008BY REPORT008BY REPORT008BY REPORT
009ALL FIXED PRICE 009 $1.00009 $1.00009 $1.00009 $1.00009 $1.00009 $1.00
010ALL PODIATRY RADIOLOGY -- -- -- -- -- -- -- -- 010 $3.82-- --
014ALL ABORTION 014 $34.46-- -- 026 $36.19026 $36.19-- -- -- --
015ALL PODIATRY SURGERY -- -- -- -- -- -- -- -- 015 $37.23-- --
016ALL GYN 016 $50.67-- -- 027 $53.22027 $53.22-- -- -- --
017ALL MEDICINE EMERGENCY -- -- 017 $1.04-- -- -- -- -- -- -- --
019ALL PODIATRY MEDICINE -- -- -- -- -- -- -- -- 019 $0.82-- --
020ALL ABORTION 020 $26.35-- -- 021 $27.66021 $27.66-- -- -- --
030ALL INJECTIONS 030 $4.46-- -- 030 $4.46030 $4.46-- -- 030 $4.46
031CHILDWELL CHILD EXAMS 031 $1.21-- -- 032 $1.50033 $1.28-- -- -- --
034ALL OB (VAGINAL DELIVERY) 034 $120.15-- -- 034 $120.15034 $120.15-- -- -- --
035ALL ABORTION 035 $37.23-- -- 036 $39.10036 $39.10-- -- -- --
037ALL ANESTHESIOLOGY (OB) 037 $17.06-- -- 039 $17.92039 $17.92-- -- 038 $13.42
040ALL OTHER OB 040 $50.67-- -- 041 $53.22041 $53.22-- -- -- --
042ALL SURGERY FIXED PRICE 042 $1.00042 $1.00042 $1.00042 $1.00042 $1.00042 $1.00
052ADULTPODIATRY PRIMARY CARE I & II - ADULT -- -- -- -- -- -- -- -- 052 $10.00-- --
052CHILDPODIATRY PRIMARY CARE I & II - CHILD -- -- -- -- -- -- -- -- 046 $10.91-- --
053ADULTPRIMARY CARE II - ADULT 053 $10.00056 $12.42050 $13.11051 $10.44-- -- -- --
053CHILDPRIMARY CARE II - CHILD 049 $10.91056 $12.42047 $14.25048 $11.36-- -- -- --
054ALL TUBAL STERILIZATIONS 054 $55.74-- -- 055 $58.54055 $58.54-- -- -- --

The conversion indicators and conversion factors listed in the Rates worksheet are used in the Medi-Cal pricing system to calculate maximum reimbursement rates for physicians, non-physician medical practitioners, hospital outpatient departments and podiatrists (for example, conversion factor X unit value equals the maximum rate). The above chart can be used to calculate rates for other provider types (for example, clinics). To calculate a rate for another provider type, multiply the procedure unit value from the Rates worksheet by the provider-specific conversion factor listed above that cross-references to the Rates worksheet conversion indicator for that particular procedure. Note also that for primary care procedures, the correct conversion factor depends on the patient's age. An adult is over 17 years of age; a child is 17 years of age or under.