forms included below are only for claims to be billed as medical claims
direct to PHC. This includes drugs to be administered directly to a
member by a medical healthcare provider (hospitals, surgery centers,
prescriber offices, and clinics). A separate form is available for non-drug per diem codes allowed
for infusion pharmacies.
• MEDICAL Benefit Drugs: TAR form for HCPCS/CPT/NDC Codes for Prescriber Administered Drugs (PADs)
Medi-Cal Rx (Pharmacy TARs):