Justice-Involved (JI) Reentry Initiative: Billing Clarification for CHW Services
| Date: | October 22, 2025 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan All Providers |
| Type: | Informational/Educational |
| Subject: | Justice-Involved (JI) Reentry Initiative: Billing Clarification for CHW Services |
| Business: | Medi-Cal Managed Care |
This is an informational item provided by the Department of Health Care Services General Medicine Bulletin, issued September 2025.
Community Based Organization (CBO) and Local Health Jurisdiction (LHJ) providers are reminded that they must use Type of Bill (TOB) 089x on the UB-04 claim form when billing for Community Health Worker (CHW) services or the claim will be denied.
Additional Billing Instructions for HCPCS Code G0022: All claims for HCPCS code G0022 must be billed after the initial billing of HCPCS code G0019, which also follows the initiating visit with the licensed Medi-Cal provider billed within the preceding six (6) months. If a licensed provider determines that social determinants of health (SDOH) need(s) change after the initiating visit, then the new SDOH need(s) and corresponding ICD-10-CM diagnosis code(s) must be used on the corresponding claim for HCPCS code G0022.
Note: Providers may only bill HCPCS code G0019 again for the same Medi-Cal member if there was another initiating visit by a licensed provider who developed a new treatment plan for a different unmet SDOH need.
CBO and LHJ providers must use modifier U2 with the above HCPCS and CPT codes to denote services rendered by CHWs. Other supervising providers should use modifier U2 with the above CPT codes to denote services rendered by CHWs. For more information on allowable modifiers, refer to the Modifiers Used with Procedure Codes section in Part 2 of the Provider Manual.
Community Health Worker (CHW) Preventive Services Provider Manual:
For additional information on claim completion, please refer to the link below:
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
