FAQ's for Medi-Cal Community Health Worker Services – Billing
The following FAQs provide additional guidance and clarification to Medi-Cal providers regarding CHW services. Please see the CHW Clinic FAQ regarding Federally Qualified Health Centers and Rural Health Clinics and the CHW G Code FAQ
Kev them nqi
1. Yuav ua li cas CHW sau lawv cov kev pabcuam rau kev them nqi?
CHWs yuav tsum tau sau cov hnub thiab sijhawm / sijhawm ntawm cov kev pabcuam muab rau cov tswvcuab Medi-Cal. Cov ntaub ntawv tseem yuav cuam tshuam txog cov lus piav qhia luv luv ntawm cov kev pabcuam ua haujlwm, uas ua raws li lub sijhawm mus ntsib. Piv txwv li, cov ntaub ntawv yuav hais tias, “Sib tham txog tus neeg mob cov teeb meem nkag mus rau cov zaub mov noj qab haus huv thiab cov kev xaiv los txhim kho qhov xwm txheej rau 15 feeb. Pab nrog SNAP daim ntawv thov rau 30 feeb. Xa tus neeg mob mus rau XYZ zaub mov pantry. " Cov ntaub ntawv yuav tsum nkag mus rau tus neeg saib xyuas raws li qhov kev thov ntawm tus neeg saib xyuas thiab yuav tsum tau saib xyuas kom tsim nyog los ntawm CHW thaum muaj kev tshuaj xyuas.
2. Cov lej them nqi rau cov kev pabcuam CHW yog dab tsi?
Cov lej hauv qab no (piv txwv li, Cov Txheej Txheem Txheej Txheem Tam Sim No (CPT) cov lej) yuav raug siv rau txhua qhov kev pabcuam CHW los ntawm tus neeg saib xyuas thaum xa daim ntawv thov:
- CPT code 98960 Kev tswj hwm tus kheej kev kawm thiab kev cob qhia, ntsib ntsej muag, 30 feeb, 1 tus neeg mob
- CPT code 98961 Kev tswj hwm tus kheej kev kawm thiab kev cob qhia, ntsib ntsej muag, 30 feeb, 2-4 tus neeg mob
- CPT code, 98962 kev kawm tswj tus kheej thiab kev cob qhia, ntsej muag-rau-tawm, 30 feeb, 5-8 tus neeg mob
Tsis tas li ntawd, DHCS tau ntxiv Healthcare Common Procedure Coding System (HCPCS) cov lej G0019 thiab G0022 raws li cov txiaj ntsig tau pib lub Plaub Hlis 1, 2025. Cov HCPCS cov lej no raug them nqi rau cov tswvcuab Medi-Cal thiab yog siv los ntawm CPT code 98960 nyob rau qee qhov xwm txheej uas CHWs xav tau ntau dua los daws cov teeb meem ntsig txog Social Determinants of Health (SDOH), uas muaj xws li vaj tse, kev kawm, thiab cov nyiaj tau los uas cuam tshuam rau tib neeg txoj kev noj qab haus huv, thiab xav kom cov tswvcuab saib xyuas kev noj qab haus huv zoo dua thiab tsim nyog. Yog xav paub ntxiv txog HCPCS cov lej G0019 thiab G0022, thov mus saib CHW G Codes FAQ.
Yog xav paub ntxiv txog cov lej sau nqi, thov mus saib hauv nqe lus them nqi ntawm Phau Ntawv Qhia Tus Kws Kho Mob: Zej Zog Kev Noj Qab Haus Huv (CHW) Kev Pabcuam Tiv Thaiv.
3. Are ICD-10 diagnosis codes required for all billable CHW services associated with CPT codes 98960 through 98962?
Yes. Effective April 1, 2025, CPT codes 98960 through 98962 require the use of an ICD-10 diagnosis code.
If the claim for CHW services is being submitting by a supervising licensed provider, the supervisor should use an appropriate diagnosis code for a licensed provider that describes the Medi-Cal members condition.
If the supervisor is not licensed, they should use an ICD-10 Z code that does not require a diagnosis from a licensed provider. Supervising providers may use one of the ICD-10 diagnosis codes listed on page 8 of the Medi-Cal Provider Manual: Community Health Worker (CHW) Preventive Services.
4. CHW puas tuaj yeem muab kev qhia thiab kev cob qhia rau ntau tshaj yim tus tswv cuab Medi-Cal ib zaug?
Yog lawm, CHWs tuaj yeem muab cov kev pabcuam hauv ib pab pawg rau ntau tshaj yim tus tswvcuab Medi-Cal; Txawm li cas los xij, tus lej siab tshaj ntawm Medi-Cal cov tswvcuab uas CHW cov kev pabcuam tuaj yeem raug them nqi hauv ib qho kev sib tham yog yim.
5. Dab tsi yog qhov ntau zaus / txwv qhov CHW tuaj yeem them nqi rau cov kev pabcuam rau ib tus tswvcuab Medi-Cal, ib hnub twg?
Qhov siab tshaj plaws yog plaub units (ob teev) txhua hnub rau Medi-Cal tus tswv cuab, txhua tus kws kho mob. Cov chav ntxiv nyob rau ib hnub tuaj yeem muab kev tso cai ua ntej rau kev tsim nyog kho mob. Kev tso cai ua ntej tuaj yeem xa tuaj tom qab muab kev pabcuam. Thov nco ntsoov tias qhov siab tshaj plaws txhua hnub txwv tsis siv rau cov kev pabcuam uas tau ua hauv ED.
6. Puas yog CHW xa daim ntawv thov nyiaj?
Tsis tau. Txij li CHWs tsis tso npe nrog DHCS, cov lus thov rau lawv cov kev pabcuam yuav tsum raug xa los ntawm ib tus kws saib xyuas uas tau sau npe mus rau Medi-Cal tus tswvcuab txoj kev npaj khomob yog tias tus tswvcuab Medi-Cal nyob hauv kev saib xyuas lossis rau DHCS yog tus tswvcuab tau them tus nqi rau kev pabcuam Medi-Cal.
7. Puas yog CHW yuav tsum tau txais daim National Provider Identifier (NPI) txhawm rau sau nqi rau cov kev pabcuam uas muab rau cov tswvcuab Medi-Cal?
Tsis yog. CHWs tsis tas yuav tau txais NPI nyob rau lub sijhawm no. Yog tias qhov kev hloov pauv no, DHCS yuav qhia rau cov neeg saib xyuas thiab CHWs ua ntej yuav ua raws li qhov yuav tsum tau ua thiab muab kev pab cuam yog tias xav tau.
8. How do CHW services interplay with Enhanced Care Management services provided by Medi-Cal managed care plans under CalAIM?
Please see Question No. 6 on the CHW FAQ for General Information.