MedicaidPrior AuthMedium impact
22-1017m Respite Services: Provide Temporary Relief for Primary Caregivers
Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net California has established new respite services for caregivers of members requiring supervision, allowing up to 336 hours per calendar year. These services require prior authorization and must be billed using specific HCPCS codes with modifier U6.
Action Required
Immediately: Billing team must update system to recognize HCPCS codes H0045, S5151, and S9125 with modifier U6 for respite services. Configure prior authorization requirements for these codes. Add eligibility verification step for ADL dependency and caregiver status. Update encounter forms to include respite service options for eligible members in covered California counties.