Certification & Payment
ACE screening is important for all patients, but in a nation-leading program, all Medi-Cal providers who screen Medi-Cal patients for ACEs can receive payment beginning on January 1, 2020.
As of July 1, 2020, Medi-Cal providers must have taken a certified training and self-attested to completing the training to continue receiving payment.
Beginning July 1, 2020, Medi-Cal providers must attest to completing certified ACE training on the DHCS website to continue receiving payments. Additional certified training opportunities may be available in 2020.
Effective January 1, 2020, Medi-Cal providers are eligible for a $29 payment for conducting ACE screenings for patients with full-scope Medi-Cal who are not dually eligible for Medi-Cal and Medicare Part B (regardless of enrollment in Medicare Part A or Part D).
In fee-for-service Medi-Cal, these payments will be paid directly to the provider submitting the claim with the HCPCS code. In Medi-Cal managed care, network providers will receive payment from the managed care plan.
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 the results of the screening:
- Screening performed – positive result indicates patient 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 – negative result indicates patient 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
* For purposes of coding, scores of 0-3 with ACE-Associated Health Conditions should be coded as G9920, even though patient falls into the high-risk category of the clinical algorithm.
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.
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 provider (per managed care plan).
- Adults age 21 up to 65: Permitted once in their adult lifetime (up to age 65), per provider (per managed care plan). Screenings completed while member is under age 21 do not count toward the one screening allowed in their adult lifetime.
Not a Medi-Cal Provider?
The $29 payment for ACE screenings is funded by Proposition 56 and is only available to enrolled Medi-Cal providers. Learn more about becoming a Medi-Cal provider at the Medi-Cal provider enrollment website.