Medi-Cal Aid Codes: How to Read Them on an Eligibility Check

Updated November 9, 2026, based on the Medi-Cal Provider Manual published by DHCS as of that date.

Medi-Cal aid codes are the two-character codes on a Medi-Cal eligibility response that name the program a member is eligible under. That program decides which services Medi-Cal will pay for and whether the member owes a share of cost first.

The same Benefits Identification Card (BIC) can sit behind full-scope coverage, coverage restricted to pregnancy and emergency care, a single program like dialysis, or a share of cost that hasn't been met. The aid code is how you tell them apart. The Medi-Cal Provider Manual's Aid Codes Master Chart lists each code with three things: its benefits, whether it carries a share of cost (SOC), and the program behind it.

What a Medi-Cal aid code tells you

DHCS built the Aid Codes Master Chart for use with the Automated Eligibility Verification System (AEVS). Its stated purpose is to help providers identify "the types of services for which Medi-Cal and public health program recipients are eligible."

A few rules from the chart's introduction shape how you read every response:

• The eligibility response includes an aid code only if the member is eligible.
• If the member has an unmet share of cost, no aid code comes back, because the member isn't eligible until the SOC is met.
• A member can have more than one aid code and be eligible for more than one program at once.
• Unless the chart says otherwise, the codes cover U.S. citizens, U.S. nationals and immigrants in satisfactory immigration status.

The chart also lists codes for programs that aren't Medi-Cal, such as the County Medical Services Program (CMSP), California Children's Services (CCS) and Every Woman Counts (EWC). Seeing an aid code doesn't always mean Medi-Cal is the payer.

Where aid codes appear on the eligibility response

The manual's Electronic Methods for Eligibility Transactions section lists three ways to check eligibility: the Medi-Cal Provider Portal, an X12 270/271 transaction, and AEVS by phone. State-approved vendor software works too.

On the phone, the AEVS: Transactions section shows what an eligible response reads back, in this order:

• The first six letters of the last name and the first initial
• The responsible county and the residence county
• The primary aid code and the first special aid code
• A prompt to call the health care plan for primary care provider information
• The Eligibility Verification Confirmation (EVC) number

After that come the eligibility messages, which spell out restrictions in words. Examples from the manual include "Beneficiary is restricted to medical services related to pregnancy and family planning" and a dialysis-only message. Other health coverage also comes back here, with the carrier code and scope of coverage.

Some timing rules from the manual's Eligibility: Recipient Identification section matter for aid codes. Outside of Immediate Need and Minor Consent cards, providers must verify on the date of service, even if they already checked that month. Eligibility can be checked for the current month and up to 12 months back, never for a future month. Per the AEVS: General Instructions section, the claim must use the same provider number, beneficiary ID and date of service as the inquiry, or it can deny for eligibility.

Reading scope of coverage: full, restricted and limited

The Benefits column in the master chart is where scope lives. The values you'll see most:

• Full: full-scope Medi-Cal for that program.
• Restricted to pregnancy-related, postpartum and emergency services. This is the scope for many codes covering people without satisfactory immigration status, such as the C, D and 58 codes. The chart describes it as pregnancy-related services, including conditions that may complicate the pregnancy, plus postpartum and emergency services. Some codes add long term care.
• Limited, or valid only for specific services. These codes cover only the services listed, such as dialysis (71), tuberculosis-related outpatient services (7H), organ transplant anti-rejection medication (77) or minor consent services (7M, 7N, 7P, 7R).
• Benefits from another program, not Medi-Cal. Codes 84, 85, 88 and 89 read "CMSP services only (no Medi-Cal)." CCS, GHPP and EWC codes work the same way for their programs.

An EVC number doesn't settle scope. The Recipient Identification section says an EVC "does not guarantee claim payment" and tells providers to read the whole response to be sure the service is covered under the member's eligibility. A restricted-scope member can get an EVC, and a routine office visit still won't be covered.

Share of cost changes what the response shows

The chart's SOC column reads Yes, No, or Y/N where the code can go either way. The Share of Cost section of the manual and AEVS: General Instructions explain how SOC changes the response:

• With an unmet SOC, the response gives the SOC dollar amount and no EVC number.
• If the member has a no-SOC aid code for some services and a SOC aid code for the rest, the response gives the aid code and EVC for the no-SOC code only, plus a SOC message for the other. The manual's example is aid code 48 for pregnancy-related services with no SOC, alongside full-scope coverage with a $500 SOC.
• The full-scope aid code won't be displayed until the SOC is met for the month.
• For aid codes 13, 23, 53 and 63, a long term care SOC is cleared on the claim, not online. The LTC facility reports it on the UB-04.
• A SOC amount tied to the 250 Percent Working Disabled Program (aid code 6G) is a premium paid to DHCS. Providers don't collect it.

For a member with a SOC, the aid code before and after the SOC is met can differ, so verify again after clearance. Our guide to Medicaid spend-down and share of cost walks through clearance transactions and billing.

Managed care or fee-for-service: the aid code isn't the plan answer

The aid code tells you scope. It doesn't tell you who to bill. Per AEVS: General Instructions, AEVS returns plan status separately. It shows prepaid health plan (PHP) status and flags fee-for-service members who are pending enrollment in a Medi-Cal managed care plan, a dental managed care plan, or both. When a fee-for-service member will join a plan next month, AEVS reads back the pending plan number and phone number "for information only."

Per the Recipient Identification section, the residence county decides which managed care plan the member can join, and the manual sends plan enrollment questions to the health care plan. Our guide to Medicaid managed care and IPA assignment covers the next step: finding the medical group or IPA that's responsible for the claim.

Common Medi-Cal aid code families and what they mean for billing

This is a sample from the Aid Codes Master Chart, not the full list.

• 10, 20, 60 (Aged, Blind, Disabled: SSI/SSP). Full scope, no SOC.
• 14, 24, 34, 64 (Medically needy, no SOC). Full scope for aged, blind, AFDC-linked and disabled members.
• 17, 27, 37, 67 (Medically needy with SOC). Full scope once the SOC is certified. Expect a SOC amount, not an aid code, until then.
• 13, 23, 63 (Long term care). Full scope, SOC Y/N. LTC SOC is cleared on the claim, not online.
• M1 and M3 (MAGI adults and parents/caretaker relatives). Full-scope, no-cost coverage. The chart lists M1 at income at or below 138 percent of FPL and M3 at or below 109 percent.
• M2 and M4. The chart lists pregnancy, 365-day postpartum, emergency and LTC services for undocumented adults and parents/caretaker relatives in those income bands.
• M7 and M9 (Pregnancy). Full-scope, no-cost coverage for citizens and lawfully present pregnant individuals.
• 76 (365-Day Postpartum Program). No SOC, the full breadth of medically necessary services through the pregnancy and 365 days postpartum, ending the last day of the month in which the 365th day falls.
• C1 through C9, D1 through D9, and 58 (OBRA). Restricted to pregnancy-related, postpartum and emergency services. Several are SOC codes (C2, C4, C6, C8 and D1, for example).
• Hospital presumptive eligibility (P1, P2, P3, H6 through H0, 7D). Full scope, no cost. P4, also a hospital presumptive code, is limited to specific prenatal ambulatory services.
• 7F and 7G (Presumptive eligibility for pregnancy). 7F covers the pregnancy test, the initial visit and services tied to it. 7G covers specific ambulatory prenatal care services.
• 80 (Qualified Medicare Beneficiary). Restricted to Medicare expenses: the Part A premium and Part A and B coinsurance and deductibles.
• 8H (Family PACT). Family planning services only. The SOC column reads N/A.
• 71 (Dialysis), 73 (Total Parenteral Nutrition). Restricted to those services; SOC Y/N.

Each chart page carries its own "Page updated" date, so check the current version before relying on a code.

A check you can run on every visit

1. Verify eligibility for the date of service, using the ID and date you'll put on the claim.
2. Record the primary aid code, any special aid codes, and the EVC number.
3. Look each aid code up in the master chart and compare its Benefits column with the service you're about to provide.
4. Read every eligibility message. Restriction and other-coverage messages carry details the code alone doesn't.
5. If a SOC amount comes back instead of an aid code, plan to collect or accept obligation, clear the SOC, and verify again.
6. Note the plan status. If the member is in or pending a managed care plan, confirm the plan and any medical group assignment before you bill.
7. Re-verify each month, and on each date of service. A member's aid code can change from one month to the next, and our guide on how often to verify insurance eligibility covers re-check timing.

Frequently asked questions

Why didn't the eligibility response return an aid code?

The most common reason is an unmet share of cost. The response gives the SOC amount instead, and the aid code appears after the SOC is certified. If the response says there's no recorded eligibility for the month, the member isn't eligible for that month.

Does an EVC number mean the claim will pay?

No. Per AEVS: General Instructions, service restrictions, SOC certification, provider eligibility and authorization requirements still apply.

Where do I find the full list of Medi-Cal aid codes?

In the Aid Codes Master Chart section of the Medi-Cal Provider Manual, on the Medi-Cal Providers website. Medi-Cal Rx, the pharmacy program, publishes its own aid code appendix with a pharmacy benefit column.

Checking Medi-Cal eligibility across portals every month?

Champ automates portal work like eligibility checks across payer portals, including Medi-Cal plan portals. We set it up and run it, so your staff sees only the finished results. If monthly Medi-Cal checks and aid code lookups are taking up your front desk's time, learn more here.

This post is general information, not legal, compliance or billing advice. Medi-Cal rules and aid codes change often, so confirm with the current Medi-Cal Provider Manual, DHCS or the member's health plan before acting. Champ is not affiliated with or endorsed by DHCS, Medi-Cal or Medi-Cal Rx.