ACEs screening training, attestation, billing and payment guidance
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Governs requirements for Medi-Cal providers contracted with MemorialCare Select Health Plan to complete ACEs training, attest to completion, use approved screening tools, document screenings, and bill HCPCS codes G9919/G9920 for directed payments; affects physicians, PPGs, hospitals, and ancillary providers (and specifies certain counties for Medi-Cal).
No material clinical or coverage changes in this revision.
ACEs Screening Coverage and Billing Criteria
ACEs screening coverage and billing criteria
Covered when ALL of the following are met:
ALL of the following
- Provider must be a contracted Medi-Cal provider with MemorialCare Select Health Plan or submit claims to Health Net for payment
- The medical plan is financially responsible; all providers delivering ACEs services must submit claims to Health Net
ALL of the following
- Provider must complete certified trauma-informed care training (including how to use PEARLS and the ACEs questionnaire) before they will be paid for dates of service on or after July 1, 2020
- Provider must self-attest via the DHCS Trauma Screening Training Attestation and provide a valid NPI on the attestation; without the attestation and valid NPI providers are not eligible to receive payment for screenings on/after July 1, 2020
ALL of the following
- ONE of: Use DHCS-approved tools appropriate to patient age: PEARLS for children/adolescents and the ACE assessment tool (or PEARLS where allowed) for adults
- Providers should retain completed screening forms in the member's medical record; forms are subject to audit
- Approved tools may be used in de-identified or identified format; de-identified format is encouraged to reduce patient discomfort
ALL of the following
- Providers must score the screening (ACE score range 0–10) and follow the DHCS risk algorithm for follow-up
ALL of the following
Frequency limits (per provider, per member)
- Under age 21: payment allowed once during a 12-month period
- Age 21 and older: payment allowed once per lifetime
ALL of the following
- Providers should determine workflow for administering the tool, who administers it, and which patients should be screened
- Screening is recommended at the beginning of an appointment; patients may take up to five minutes to complete the tool
- Providers must develop follow-up/referral plans (including behavioral health resources and warm hand-offs) appropriate to risk level
ALL of the following
- This Medi-Cal directed payment notice applies to providers in Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties (as specified by the plan) when submitting to Health Net/Medical plan
HCPCS Codes, Payment Amounts, and Frequency
Training, Attestation, Billing, and Documentation Requirements
Complete certified trauma‑informed training and self‑attest (effective 7/1/2020)
Contracted Medi‑Cal providers who plan to screen for ACEs must complete certified trauma‑informed care training that includes how to use the PEARLS tool and the ACEs questionnaire, and must self‑attest using the DHCS Trauma Screening Training Attestation to be eligible for payment. The training requirement is effective for dates of service on or after July 1, 2020; it was waived for dates of service prior to July 1, 2020. Registration is available for the two‑hour online training at the DHCS training site.
- Training must include use of the Pediatric ACEs Screening and Related Life‑events Screener (PEARLS) and the ACEs questionnaire.
- Register for the two‑hour online training at http://training.acesaware.org.
- Self‑attest via the DHCS Trauma Screening Training Attestation form (https://www.medi-cal.ca.gov/TSTA/TSTAattest.aspx).
Bill correct HCPCS and submit clean claims within one year
Bill the matching HCPCS code for the screening result: G9919 for positive/high‑risk screenings (ACE score 4 or greater) and G9920 for negative/lower‑risk screenings (ACE score 0–3). Submit clean claims to Health Net within one year from the date of service; payments for G9919 or G9920 are processed within 90 calendar days of receipt.
- G9919 — positive results and provision of recommendations given; ACEs screening score 4 or greater; payment amount $29.00.
- G9920 — negative results; ACEs screening score 0–3; payment amount $29.00.
- All providers delivering ACEs services must submit claims to Health Net; the medical plan is financially responsible.
- Under age 21: payment allowed once per 12‑month period per member per provider; Age 21 and up to 65: payment allowed once per lifetime per member per provider.
Attestation must include a valid NPI — payment withheld without it
The DHCS attestation must include a valid NPI; providers who have not attested or who do not include a valid NPI will not be eligible to receive payment for screenings on or after July 1, 2020.
- You must attest with a valid NPI number on the DHCS Trauma Screening Training Attestation, or you will not be eligible for payment.
- Health Net provider support can verify DHCS receipt of the ACEs training attestation.
Screening Tools and Assessment Definitions
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