How do I become a CDP provider?

To become a CDP provider, a Primary Care Provider (PCP) must:

• Be a Medi-Cal provider in good standing and licensed in the State of California.

• Enroll into the program through the Orange County Cancer Detection Partnership. Complete and sign a Primary Care Provider Enrollment Agreement (PCPEA).

• Have Internet access.

Prior to providing services, all new PCPs must receive training about program standards and requirements, submission of hard copy or electronic claims, and submission of outcome data via the online database.  New PCPs are eligible to render services only after the effective date of enrollment, as stated in the CDP: EWC welcome letter.  PCPs must adhere to all requirements contained in the Primary Care Provider Enrollment Agreement (PCPEA) as well as to clinical standards and data submission requirements set forth by the Cancer Detection Section of the California Department of Public Health.

Contact Sharri Mahdavi, the Clinical Coordinator, at smahdavi@ochca.com or (714) 834-6193, to get an application. Not all prospective providers are allowed to enroll.

What services are covered by CDP:EWC?

Breast Cancer Screening and Diagnostic Services for women ages 40 and older including:

• Office Visit – Breast Screening
  Clinical Breast Exam (CBE); Repeat exams are allowed for follow–up of abnormal findings.  

• Screening Mammogram
  Each PCP can order one screening mammogram per year for each woman.

• 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.

• Diagnostic Mammogram
  A diagnostic mammogram is reimbursable when either the CBE or the screening mammogram is abnormal. Repeated diagnostic mammograms, if indicated, are also reimbursable.

• Other Diagnostic Services
  Additional reimbursable breast diagnostic services include ultrasound, Fine Needle Aspiration (FNA), core needle and/or excisional biopsies. Diagnostic services are reimbursed until pathologic diagnosis of cancer or not cancer is made.  Cancer treatment is not covered by CDP: EWC. The woman can be referred to the Breast and Cervical Treatment Program (BCCTP) for assistance with cancer treatment costs. For more information about the BCCTP, visit http://www.dhcs.ca.gov/services/medi-cal/Pages/BCCTP.aspx.

• Cervical screening
  Pelvic exam and Pap Smear

• Colposcopy
  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.

Claims for CDP: 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:

For More Information for Primary Care Providers
www.cdph.ca.gov/programs/CancerDetection/Pages/PCPProgramManualsAndInformation.aspx