MedicaidPrior AuthMedium impact
22-1076 ECM Services Won't Need Prior Authorization in 2023
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Enhanced Care Management (ECM) codes G9008 and G9012 no longer require prior authorization for CalViva Health Medi-Cal members effective January 1, 2023. This streamlines the billing process for these case management services in Fresno, Kings, and Madera counties.
Action Required
Immediately: Billing team must update prior authorization requirements in billing system to remove PA requirement for HCPCS codes G9008 and G9012 for CalViva Health Medi-Cal patients. Update encounter forms and billing workflows to reflect that these ECM services can be billed directly without prior authorization. Continue using standard referral process for ECM services.