MedicaidPrior AuthMedium impact
22-1073 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 submit claims for these care management 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 encounter forms and billing workflows to reflect that these Enhanced Care Management services can be billed directly without prior approval. Verify billing software no longer flags these codes for authorization.