G9919 Insurance Policy Changes

HCPCS G9919 is officially defined as "Screening performed and positive and provision of recommendations." HCPCS G9919 is referenced in 7 tracked payer policy changes from NC Medicaid - NCDHHS, Health Net, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G9919 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

NC Medicaid - NCDHHS · Effective Dec 31, 2026High impact
NC Integrated Care for Kids Closeout and Related Billing Code Changes
NC Medicaid is closing the NC Integrated Care for Kids (InCK) pilot program effective December 2026. Two food/housing screening G codes (G9919, G9920) will be rejected after December 31, 2026, while the Kindergarten Readiness Promotion Bundle code (CPT 1003F with modifiers SE, TS) will continue indefinitely for well-child visits in children ages birth to 6. Billing teams must stop using the discontinued G codes and ensure proper use of CPT 1003F with appropriate modifiers to document bundle completion.
Health Net · Identified Jun 20, 2026High impact
20-508 Learn How to Bill ACEs Screening HCPCS Codes G9919 and G9920
CalViva Health in Fresno, Kings and Madera counties will now directly reimburse HCPCS codes G9919 and G9920 for ACEs screening services. Providers must complete state-certified training by June 30, 2020 and self-attest by July 1, 2020 for continued reimbursement.
Missouri Medicaid (MO HealthNet) · Effective Jul 1, 2026Medium impact
Screening for Adverse Childhood Experiences (ACEs) for Individuals Under Age 21
MO HealthNet will begin covering ACEs (Adverse Childhood Experiences) screening for individuals under age 21 effective July 1, 2026, using new HCPCS codes G9919 and G9920 with modifier HA. Providers must complete mandatory ACEs Aware training to receive reimbursement, and screening is limited to one unit per calendar year per provider.
Health Net · Identified Jun 20, 2026Medium impact
20-408 Use These Guidelines to Improve Trauma-Informed Care for Patients with ACEs
CalViva Health has issued new guidelines for trauma-informed care and ACEs (Adverse Childhood Experiences) screening for Medi-Cal patients in Fresno, Kings and Madera counties. Providers can bill $29 using HCPCS codes G9919 (high risk score 4+) or G9920 (lower risk score 0-3) for ACEs screenings, with specific frequency limitations and mandatory training requirements for payment after June 30, 2020.
Health Net · Identified Jun 20, 2026Medium impact
24-1163m Complete Mandatory Training, Get Prop 56 Payments
Healthcare providers can now earn $29 payments for conducting ACEs (Adverse Childhood Experiences) screenings using specific tools based on patient age, but must complete mandatory trauma-informed care training first. Billing uses HCPCS codes G9919 (positive results) and G9920 (negative results) with frequency limits based on patient age.
Health Net · Identified Jun 20, 2026Medium impact
24-1164m Complete Mandatory Training, Get Prop 56 Payments
New Prop 56 payment opportunity for ACEs (Adverse Childhood Experiences) screening using specific HCPCS codes G9919 and G9920, each paying $29.00. Providers must complete mandatory trauma-informed care training through DHCS and self-attest before billing for these screening services.
Health Net · Identified Jun 20, 2026Medium impact
24-1162m Complete Mandatory Training, Get Prop 56 Payments
Health Net now provides $29 payments for ACEs (Adverse Childhood Experiences) screenings using HCPCS codes G9919 and G9920, but providers must complete mandatory trauma-informed care training first. Payments are limited to once per 12 months for patients under 21 and once per lifetime for adults 21-64.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect HCPCS G9919?

There are 7 tracked policy changes affecting HCPCS G9919, including updates from NC Medicaid - NCDHHS, Health Net, Missouri Medicaid (MO HealthNet). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS G9919?

Payers that have issued tracked updates for HCPCS G9919 include: NC Medicaid - NCDHHS, Health Net, Missouri Medicaid (MO HealthNet).

How do I get notified when HCPCS G9919 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS G9919. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS G9919?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

All billing codes J3590 C9399 J3490 99215 99213 99202

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NC Integrated Care for Kids Closeout and Related Billing Code Changes

20-508 Learn How to Bill ACEs Screening HCPCS Codes G9919 and G9920

Screening for Adverse Childhood Experiences (ACEs) for Individuals Under Age 21

20-408 Use These Guidelines to Improve Trauma-Informed Care for Patients with ACEs

24-1163m Complete Mandatory Training, Get Prop 56 Payments

24-1164m Complete Mandatory Training, Get Prop 56 Payments

24-1162m Complete Mandatory Training, Get Prop 56 Payments

What insurance policy changes affect HCPCS G9919?

Which payers have updated policy for HCPCS G9919?

How do I get notified when HCPCS G9919 policy changes?

Why do payers change policies for HCPCS G9919?