All PlansPrior AuthMedium impact
22-1074 ECM Services Won't Need Prior Authorization in 2023
Health Net·CA · Family Medicine, Internal Medicine, General Practice·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 effective January 1, 2023. Billing teams can now submit claims for these services without obtaining prior approval first.
Action Required
Immediately: Billing team must update system settings to remove prior authorization requirements for HCPCS codes G9008 and G9012. Update billing workflows and staff training to reflect that these enhanced care management services can now be billed directly without PA. Continue using standard referral processes for ECM services.