Welcome to the Department of Health Care Services Welcome to Medi-Cal Welcome to the Department of Health Care Services

Medi-Cal Logo
Click to Sign Up for MCSS emails

New Health Assessment Benefits

July 15, 2016

Effective for dates of service on or after July 1, 2016, the following health assessment services are new benefits of the Child Health and Disability Prevention (CHDP) program.

Code Service Description Age Rate
B1 Autism screening 0 through 16 years, 11 months $ 54.90
B2 Dyslipidemia screening 2 years through 20 years, 11 months $ 11.63
B3 Psychosocial/behavioral assessment 0 through 20 years, 11 months $ 18.03
B4 Psychosocial/behavioral reassessment 0 through 20 years, 11 months $ 17.44
B5 HIV screening (HIV-1 and HIV-2 single result) 10 years, 11 months through 20 years, 11 months $ 12.33
B6 HIV screening (HIV-1 antigen[s], with HIV-1 and HIV-2 antibodies, single result) 10 years, 11 months through 20 years, 11 months $ 20.26
B7 Alcohol and drug use assessment 10 years, 11 months through 20 years, 11 months $ 24.00

The Confidential Screening/Billing Report (PM 160) claim form is not pre-printed with the new interim codes. For claim completion instructions, billers should follow the “Other Tests” instructions in the Confidential Screening/Billing Report (PM 160) Claim Form: Completion Instructions section of the CHDP Provider Manual.

On July 1, 2016, the Bright Futures health assessment periodicity schedule will be implemented for children/youth not enrolled in a Medi-Cal managed care plan. The Bright Futures periodicity schedule supersedes the CHDP Periodicity Schedule for Health Assessment Requirements by Age Groups and adds 14 additional health assessment visits to the 15 health assessment visits already reimbursable for children and youth from birth to age 21. The health assessment services/codes identified in this NewsFlash coincide with services provided under the Bright Futures periodicity schedule.

Manual pages reflecting this information will be released with a future CHDP Update.