December 24, 2020
Effective retroactively for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal covered benefit. Medi-Cal shall reimburse for ACEs screenings for both children, up to 18 years of age, 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 are eligible receive these payments, in addition to their Prospective Payment System (PPS) or all-inclusive rate (AIR) per-visit reimbursement.
On May 8, 2020, a Medi-Cal NewsFlash titled "ACEs and Childhood Developmental Screening Trainings Ready for FQHC/RHC/IHS-MOA" informed providers that the Adverse Childhood Experiences (ACEs) and Childhood Developmental Screening Recorded Webinar was available for providers to view. The recorded webinar provides information regarding billing for ACEs and Childhood Developmental Screening when rendered by Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services (IHS)/Memorandum of Agreement (MOA) clinics to participants in the Medi-Cal program.
On April 20, 2020, a Medi-Cal NewsFlash titled "Screening for Adverse Childhood Experiences Is a Medi-Cal Covered Benefit" informed providers that the new billing policy related to ACEs was implemented and effective for dates of service January 1, 2020.
On April 22, 2020, a Medi-Cal NewsFlash titled "New Medi-Cal Policy for Childhood Developmental Screening Reimbursement" informed providers that the new billing policy related to Childhood Developmental Screening was implemented and effective for dates of service from January 1, 2020, through December 31, 2021.
The billing guidelines for ACEs and Childhood and Adult Developmental Screening are located within the recorded webinar, which can be found under the Medi-Cal Learning Portal. Providers must create an account to access any trainings published under the Medi-Cal Learning Portal.
The billing guidelines for ACEs Screenings are summarized as follows:
- Providers must first complete the Department of Health Care Services (DHCS) training for ACEs and trauma-informed care prior to conducting a screening.
- ACEs screening supplemental payments are limited to one screen per beneficiary per lifetime; however, additional screenings can be provided if it is deemed medically necessary.
- ACEs screenings, rendered to Medi-Cal fee-for-service (FFS) beneficiaries performed by FQHCs, RHCs and IHS-MOA Clinics, will be paid up to the FFS reimbursement rate of $29.00.
- When billing for ACE screenings, HCPCS code G9919 (screening performed and positive and provision of recommendations) is used for high-risk patients with a screening score of 4 or greater. HCPCS code G9920 (screening performed and negative) is used for lower-risk patients with a screening score of 0 to 3.
- When a face-to-face medical visit occurs, codes G9919 or G9920 are billed with the HIPPA-compliant billing code on the UB-04 claim form.
- ACEs screenings provided to Medi-Cal Managed Care Plan (MCP) beneficiaries are to be billed to their respective MCP.
The billing guidelines for Childhood and Adult Developmental Screenings are summarized as follows:
- Developmental screenings are performed at well-child visits at 9, 18 and 30 months of age, and when medically necessary, based on developmental surveillance.
- Providers must use a standardized developmental screening tool that meets the criteria established by the American Academy of Pediatrics and the Centers for Medicare and Medicaid Services (CMS).
- Developmental screenings, rendered to FFS beneficiaries, performed by FQHCs, RHCs and IHS-MOA Clinics, will be paid the FFS reimbursement rate of $70.00.
- CPT® code 96110 (developmental screening [eg, developmental milestone survey, speech and language delay screen], with scoring and documentation, per standardized instrument) is used when billing for developmental screenings.
- When a face-to-face medical visit occurs, CPT code 96110 is billed with the HIPPA-compliant billing code on the UB-04 claim form.
- Developmental screenings provided to MCP beneficiaries are to be billed to their respective MCP.