|Date:||December 9, 2019|
|To:||Health Plan of San Joaquin (HPSJ) Practitioners and Providers|
|From:||HPSJ Claims Department|
|Subject:||Prop 56 – Childhood Development Screening Update & Provider Training
The Department of Health Care Services (DHCS) has added additional reimbursement for
developmental screening for dates of service from January 1, 2020, through December
Health Plan of San Joaquin (HPSJ) will reimburse providers for developmental screenings
with funds from the California Healthcare, Research and Prevention Tobacco Tax Act of
2016 (Proposition 56). The Fiscal Year 2019 – 2020 Governor’s budget included funds to
be allocated for payments to support developmental screenings for children enrolled in
full-scope Medi-Cal coverage under the Early and Periodic Screening, Diagnostic and
Treatment (EPSDT) benefit.
Providers must use a standardized screening tool that meets the criteria set forth by the
American Academy of Pediatrics (AAP) and the Centers for Medicare & Medicaid Services
(CMS). The requirements for billing are:
Reviewed completed screen
2. Standardized screening tool used
3. Results documented and interpreted
4. Results discussed with child’s family and/or caregiver
5. Any clinically appropriate actions documented
*Documentation should remain in the beneficiary’s medical record and be available
The developmental screenings are reimbursed under the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with CPT code 96110 (developmental screening, with scoring and documentation, per standardized instrument) without the use of modifier KX. For Medi-Cal MCPs, developmental screenings are reimbursed at a rate of $59.90 in addition to any reimbursement the network provider would normally receive.
Prop 56 – Childhood Development Screening Update & Provider Training
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian
Health Services –
- Under Memorandum of Agreement (IHS-MOA) 638
- The clinics providers are reimbursed at a rate of $59.90 in addition to their Prospective Payment System (PPS) reimbursement and all-inclusive rate.
- Additional information about how FQHC/RHC/IHS-MOA providers should bill for development screening will be released in a future Medi-Cal Update.
- All supplemental payments will be going through our payment processing vendor,
Change Healthcare, in a separate check from the regular FFS payments.
- The Remittance Advice (RA) will identify the supplemental payment with SUPP
indicated on the claim line level.
If you have questions, please contact our Customer Service Department at 209-942-6320.