Billing & Payment
Qualified Medi-Cal providers can receive payment for screening children and adults for ACEs
Effective January 1, 2020, Medi-Cal providers became eligible for a $29 payment for conducting ACE screenings for child and adult patients with full-scope Medi-Cal. Payment is not available for patients age 65 and older or for those who are dually eligible for Medi-Cal and Medicare Part B (regardless of enrollment in Medicare Part A or Part D).
Qualifying ACE screenings are eligible for payment in any clinical setting in which billing occurs through Medi-Cal fee-for-service or to a network provider of a Medi-Cal managed care plan.
- Medi-Cal Managed Care
Network providers will receive payment from managed care plans in addition to whatever the provider is paid by the managed care plan for the accompanying office visit.
Payments will follow the typical process and will be paid directly to the provider submitting the claim.
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Cost-Based Reimbursement Clinic (CBRCs), and Indian Health Services (IHS) are also eligible for the $29 payment.
Medi-Cal Billing Codes
The following Healthcare Common Procedure Coding System (HCPCS) should be used to bill Medi-Cal based on ACE screening results:
- Screening performed – result indicates patient is at high risk for toxic stress; education and interventions (as necessary) provided*
- Providers must bill this HCPCS code when the patient’s ACE score is 4 or greater (high risk)
- Payment: $29
- Screening performed – result indicates patient is at lower risk for toxic stress; education and interventions (as necessary) provided*
- Providers must bill this HCPCS code when the patient’s ACE score is between 0 – 3 (lower risk)
- Payment: $29
* Billing and coding are based solely on the total ACE score. The ACE score refers to the total reported categories of exposure from among the 10 ACEs, indicated in the ACE Questionnaire for Adults or Part 1 of the pediatric PEARLS. ACE scores range from 0 to 10.
Providers must document all of the following:
- The screening tool that was used;
- That the completed screen was reviewed;
- The results of the screen;
- The interpretation of results; and
- What was discussed with the member and/or family, and any appropriate actions taken.
This documentation must remain in the beneficiary’s medical record, and be available upon request.
Clinical risk assessment and management should be pursued according to the ACE Screening Clinical Workflows, ACEs and Toxic Stress Risk Assessment Algorithm, and ACE-Associated Health Conditions (ADA Version) guidelines.
Medi-Cal payment is available for ACE screenings based on the following schedule:
- Children and adolescents under age 21: Permitted for periodic ACE rescreening as determined appropriate and medically necessary, not more than once per year, per clinician (per managed care plan).Children should be screened periodically to monitor the possible accumulation of ACEs and increased risk for a toxic stress physiology.
- Adults age 21 through age 64: Permitted once in their adult lifetime (through age 64), per clinician (per managed care plan). Screenings completed while the person is under age 21 do not count toward the one screening allowed in their adult lifetime. Adults should be screened at least once in adulthood—and though ACEs occur in childhood (by definition) and therefore do not change, patient comfort with disclosure may change over time, so re-screening for adults may be considered.
Billing for ACE Screening via Telehealth
Providers may screen a patient for ACEs via telehealth if the provider believes that the ACE screening can be administered in a clinically appropriate manner via telehealth, per new DHCS guidance in response to COVID-19. Providers must continue to comply with all other billing procedures, Medi-Cal guidelines, and confidentiality laws.
Under the existing ACE screening policy, providers must document all of the following: the tool that was used, that the completed screen was reviewed, the results of the screen, the interpretation of results, what was discussed with the member and/or family, and any appropriate actions taken. This documentation must remain in the beneficiary’s medical record and be available upon request.
See more information about telehealth and virtual/telephonic communications under the COVID-19-related guidance.
Not a Medi-Cal Provider?
The $29 payment for ACE screenings is funded by Proposition 56 and is only available to Medi-Cal providers.
You can still get trained and use the ACE Screening Workflows, Risk Assessment and Treatment Algorithms, and ACE-Associated Health Conditions (ADA Version).
If you are interested in becoming a Medi-Cal provider, visit the DHCS Provider Enrollment web page.