Cov FAQs hauv qab no muab kev taw qhia ntxiv thiab kev qhia meej rau Medi-Cal cov tswv cuab thiab cov kws kho mob txog CHW cov kev pabcuam.​​  

Cov ntaub ntawv dav dav​​  

1. Cov kev pab twg yuav muab tau nrog Healthcare Common Procedure Coding System (HCPCS) G0019 thiab G0022?​​  

Siv tau rau cov hnub ua haujlwm rau lossis tom qab lub Plaub Hlis 1, 2025, HPCS cov lej G0019 thiab G0022 yuav raug siv rau txhua qhov kev pabcuam CHW uas teev nyob rau hauv Phau Ntawv Qhia Medi-Cal Tus Muab Kev Pabcuam: Cov Kev Pabcuam Kev Noj Qab Haus Huv Hauv Zej Zog, suav nrog kev kawm txog kev noj qab haus huv, kev noj qab haus huv kev taw qhia, kev tshuaj xyuas thiab kev soj ntsuam, thiab kev tawm tswv yim.​​  

2. Puas yog yuav tsum tau mus ntsib thawj zaug ua ntej CHW cov kev pabcuam tuaj yeem raug them rau Healthcare Common Procedure Coding System (HCPCS) G0019 thiab G0022?​​  

Yog lawm. Kev pib mus ntsib yog ib feem ntawm HCPCS cov lus piav qhia thiab DHCS tsis muaj txoj cai los hloov kho cov cai ntawm HCPCS cov cai kom tshem tawm qhov pib mus ntsib yam tsis tau nrhiav kev pom zoo los ntawm Lub Chaw rau Medicare thiab Medicaid Services (CMS).​​    

3. Hom kev mus ntsib twg yuav suav tias yog kev mus ntsib thawj zaug?​​  

Kev pib mus ntsib yuav tsum tau them nqi nrog ib qho ntawm Cov Kev Ntsuas thiab Kev Tswj Xyuas Cov Cai hauv qab no: ​​  

Chaw ua hauj lwm lossis lwm qhov kev pab cuam kho mob sab nraud: CPT tus lej 99203-99205 thiab 99213-99215 ​​   

Cov kev pabcuam hauv tsev lossis chaw nyob: CPT codes 99342, 99344-99345, thiab 99348-993450 ​​  

Cov kev pabcuam tshuaj tiv thaiv: CPT codes 99381-99387 thiab 99391-99396 ​​   

4. Puas yog ib txoj kev kho mob uas yuav tsum tau them nqi rau HCPCS cov lej G0019 thiab G0022.​​   

Yog lawm. Txoj kev npaj kho mob lossis kev npaj saib xyuas yog ib feem ntawm txoj cai txhais ntawm HCPCS code G0019. Nws yuav tsum txheeb xyuas qhov tsis sib haum xeeb ntawm Social Determinant (s) of Health (SDOH) uas txwv tsis pub muaj peev xwm ntawm tus kws kho mob ntawm qhov pib mus kuaj mob lossis kho cov teeb meem. Nws yuav tsum muaj cov hom phiaj thiab cov kauj ruam kom ua tiav cov hom phiaj, raws li tau piav qhia hauv qab no.​​   

5. Dab tsi yuav tsum tau rau txoj kev npaj kho mob?​​   

Txoj kev npaj khomob yuav tsum suav nrog ib lossis ntau dua ICD-10 tus lej kuaj mob rau cov kev xav tau ntawm SDOH uas tsis tau txais thiab qhia txog cov hom phiaj dav dav rau Medi-Cal tus tswvcuab. CHW tuaj yeem pab txhim kho txoj kev npaj kho mob txhawm rau txheeb xyuas kev txhawb nqa thiab kev pabcuam kom ua tiav cov hom phiaj. Daim phiaj xwm kawg ntawm kev saib xyuas / kev kho mob yuav tsum tau muab qhia rau CHW tus saib xyuas thiab tus kws kho mob uas muaj ntawv tso cai ntawm qhov pib mus ntsib.​​   

6. Puas yog tus kws kho mob uas pib mus ntsib yuav tsum yog tib tus kws kho mob uas tsim cov phiaj xwm kho mob?​​   

Tsis yog. Tus kws kho mob pib mus ntsib lossis lwm tus kws kho mob muaj ntawv tso cai uas paub txog tus neeg mob tuaj yeem tsim cov phiaj xwm kev saib xyuas lossis kev kho mob uas qhia txog cov hom phiaj dav dav uas piav qhia txog cov kev xav tau rau Medi-Cal tus tswv cuab uas yuav tau hais los ntawm CHW nrog rau lwm yam kev txhawb nqa thiab kev pabcuam, yog tias tsim nyog. CHWs tuaj yeem yog ib feem ntawm pab pawg ntawm cov chaw muab ntawv tso cai uas tsim kho txoj kev npaj khomob thiab ntxiv cov kev pabcuam uas CHW yuav ua los hais txog SDOH.​​    

Tsis tas li ntawd, CHW kuj tseem tuaj yeem tsim cov phiaj xwm kev saib xyuas lossis kev kho mob uas txheeb xyuas cov kev cuam tshuam rau CHW cov kev pabcuam, tom qab ntawd raug tshuaj xyuas thiab pom zoo los ntawm tus kws kho mob uas muaj ntawv tso cai uas tej zaum yuav yog tus kws kho mob sib txawv dua li tus uas tau pib mus ntsib, raws li tau piav qhia hauv tsab cai no, thiab kuj tau koom nrog CHW tus saib xyuas thiab cov neeg muab ntawv tso cai ntawm qhov pib mus ntsib.​​    

For example, if a CHW chooses to draft a treatment plan for a Medi-Cal member following an initiating visit with nurse practitioner (NP) in which unmet SDOH needs are identified that significantly limit the ability of the NP to diagnose or treat problems, it would then be shared with the CHW’s licensed clinical social worker or other licensed provider who would review the plan and share as described above.​​   

7. Puas muaj lub sijhawm them nqi HCPCS code G0019?​​   

Yog lawm. Ib tus kws kho mob uas muaj ntawv tso cai yuav tsum tau pib mus ntsib nrog Medi-Cal tus tswv cuab tau them nqi nrog ib qho ntawm cov lej teev tseg hauv Nqe Lus Nug 2 nyob rau hauv rau lub hlis dhau los ua ntej them nqi CHW cov kev pabcuam nrog HCPCS code G0019.​​    

8. Puas yog ICD-10 kev kuaj mob code tsim nyog raws li kev sau ntawv SDOH?​​    

Yog lawm, tus kws kho mob muaj ntawv tso cai uas txheeb xyuas qhov kev xav tau ntawm SDOH uas tsis tau txais (lossis ntau qhov kev xav tau SDOH) tuaj yeem sau SDOH los ntawm kev siv tus lej kuaj mob uas tsim nyog ICD-10.​​   

9. Cov kws kho mob tuaj yeem pom zoo rau CPT tus lej 98960-62 tuaj yeem ua qhov pib mus ntsib?​​   

While DHCS provided great flexibilities for providers who can recommend CHW services billed by CPT codes 98960-98962, only providers who may bill with E&M codes listed in Question 2 may conduct the initiating visit. The flexibilities that DHCS allows for the recommending provider, including out-of-network providers for CPT codes, does not align with the requirement for an initiating visit billed with G0019 prior to billing G0022. Requiring an Evaluation and Management Code for the initiating visit is consistent with CMS’ policy guidance and it allows DHCS to confirm that an initiating visit occurred prior to G0019 being billed for a Medi-Cal member.​​   

10. Lub sijhawm uas CHWs puas tuaj yeem siv ua haujlwm sawv cev ntawm Medi-Cal tus tswvcuab uas nrog cov tswvcuab suav rau tag nrho cov nyiaj siv rau lub hli?​​   

DHCS tau siv tib txoj cai piav qhia raws li Medicare uas tso cai rau kev them nyiaj rov qab rau cov kev pabcuam tsim nyog thiab tsim nyog.​​   

11. Cov lej no puas tuaj yeem siv rau kev pabcuam los ntawm telehealth?​​   

Yog lawm, yog tias tus tswvcuab tso cai tau txais kev pabcuam los ntawm telehealth thiab CHW ntseeg tias lawv tuaj yeem tsim nyog los ntawm telehealth, cov HCPCS cov lej no yuav raug siv rau kev noj qab haus huv, raws li cov lus qhia hauv xov tooj uas tau tshaj tawm hauv Medi-Cal Tus Muab Kev Pabcuam Phau Ntawv Qhia: Telehealth.​​   

12. Puas tuaj yeem pom zoo rau CHW cov kev pabcuam los ntawm kev siv rau HCPCS cov lej G0019 thiab G0022?​​    

Tsis yog, vim tias kev pib mus ntsib thiab txhim kho txoj kev npaj khomob / phiaj xwm kev saib xyuas yuav tsum tau ua ua ntej kev them nqi HCPCS cov lej G0019 thiab G0022. Cov lus pom zoo sawv cev tsuas yog tso cai txog 12 units yog tias siv CPT code 98960, ib tus tswv cuab txhua xyoo.​​ 

13. HCPCS cov lej G0019 thiab G0022 puas tuaj yeem siv rau Kev Pabcuam Kev Ncaj Ncees?​​   

Tsis muaj. Tsuas yog CPT cov lej 98960-98962 tuaj yeem siv rau CHW cov kev pabcuam muab rau JI cov kev pabcuam.​​   

14. Puas yog DHCS nrhiav cov neeg koom nrog cov tswv yim ua ntej siv G codes?​​     

Yog lawm. DHCS tau xa tsab cai no mus rau 10 lub koom haum thiab tau txais cov lus pom los ntawm 14 lub koom haum ua ntej ua tiav txoj cai.​​