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Instruction Details
Use '*' for all payers
Use '*' for all specialties
Use '*' for all states
Lower numbers have higher priority (default: 100)
Only active instructions are considered during evaluation
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Define when and how this instruction should be applied. Include criteria for evaluation and priority rules.
Critical instructions for emergency situations. This content will be prioritized during urgent cases.
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Preview
Match Criteria:
Medicare Dermatology California
Specificity Score: 7
Higher scores indicate more specific matches
Priority: 5
Status:Active
Instructions Preview:
# Medicare Dermatology Coding - California

## State-Specific Requirements
- California has specific documentation requirements for dermatology procedures
- Some procedures require prior authorization
- Follow California Medical Board guidelines

## Medicare-Specific Rules
- Use appropriate HCPCS codes for Medicare patients
- Document medical necessity for all procedures
- Include appropriate modifiers for California Medicare claims

## Common Issues
- Ensure proper documentation for Mohs surgery
- Document patient education provided
- Include appropriate follow-up scheduling
Evaluation Rules Preview:
# Medicare Dermatology - California Evaluation Rules

## When to Apply This Rule
- Patient has Medicare insurance
- Provider is dermatology specialist
- Service is provided in California
- All three criteria must be met

## Evaluation Criteria
1. Insurance Verification: Confirm Medicare eligibility
2. Specialty Verification: Confirm dermatology specialty
3. Location Verification: Confirm California location
4. State Requirements: Verify California-specific requirements

## Priority Application
- Highest priority for Medicare dermatology cases in California
- Overrides all other Medicare and dermatology rules
- Apply only when all three criteria are met exactly
Help
Wildcard Usage:
  • * in any field means "all" for that criteria
  • More specific rules (fewer wildcards) take priority
  • Priority field breaks ties between equally specific rules
Examples:
  • Medicare, *, * - Applies to all Medicare cases
  • *, Dermatology, * - Applies to all dermatology cases
  • Medicare, Dermatology, California - Most specific rule