MedicaidPrior AuthMedium impact
22-1016m Respite Services: Provide Temporary Relief for Primary Caregivers
Health Net·CA · Family Medicine, Pediatrics, Geriatrics +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health now covers respite services for caregivers of Medi-Cal members who need temporary supervision, with up to 336 hours per calendar year. Prior authorization is required for these services using specific billing codes with modifier U6.
Action Required
Immediately: Billing team must set up prior authorization requirements for respite service codes H0045, S5151, and S9125 when used with modifier U6. Update billing system to track the 336-hour annual limit per member. Add eligibility verification step to confirm member lives in community and has ADL dependencies. Access CalAIM Resources authorization guides on provider portal for specific approval criteria.