The California Department of Health Care Services recently announced that it will be deactivating Medi-Cal Rx override code “55555” effective October 18, 2024. This code had been created during the Medi-Cal Rx transition to override claim denials at the point of service when there was evidence of a prior valid prior authorization or paid claim.  

While Medi-Cal Rx discontinued the bypass code for certain drugs/products in November 2023, the “55555” override code will no longer be accepted for any drug/product claims effective Oct. 18. As a result, all claims will be subject to Medi-Cal Rx claim utilization management edits, and a prior authorization request submission may be required for coverage considerations. 

For More Information: Deactivation of Override Code “55555” for All Drugs/Products – Medi-Cal Rx Program Integrity Update