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Screening for Adverse Childhood Experiences Is a Medi-Cal Covered Benefit

April 20, 2020

Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal covered benefit. Medi-Cal will begin reimbursing for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with Proposition 56 funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services (IHS) — Memorandum of Agreement (IHS-MOA) 638 Clinics will also be able to receive these payments, in addition to the Prospective Payment System (PPS) or all-inclusive rate (AIR) per-visit reimbursement.

Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be paid more than once per year, per provider. Screenings for individuals 21 years of age and older will not be paid more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-Events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age and older. For individuals 18 and 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age and older is used, it must contain questions on the 10 original categories of ACEs to qualify.

ACEs screenings will be reimbursed in both the fee-for-service and managed care delivery systems when billed with either of the two HCPCS codes below:

  • G9919 – High-risk, patient score of 4 or greater
  • G9920 – Lower-risk, patient score of 0-3

In the fee-for-service delivery system, providers will be reimbursed up to the max Medi-Cal rate of $29, subject to Medi-Cal policy. In the managed care delivery system, Medi-Cal managed care plans will reimburse network providers no less than $29, for each qualifying ACEs screening. Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family and any clinically appropriate actions were taken. This documentation should remain in the beneficiary’s medical record and be available upon request.

More information about the ACEs Aware Initiative is available here: https://www.acesaware.org/.

For ACEs screenings provided to beneficiaries enrolled in a Medi-Cal managed care plan, please refer to the plan’s billing and claims policies and guidance.

In order to be eligible for the trauma payment after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care and attest on the Medi-Cal website.

For more information, providers may visit the DHCS Trauma Screenings and Trauma-Informed Care webpage.