MedicaidPrior AuthMedium impact
20-686 Age Limit Change for Developmental Screening with CPT Code 96110
Health Net·CA · Pediatrics, Family Medicine·Prior Authorization
Effective date
Nov 10, 2020
We identified it
Jun 20, 2026
Summary
Medi-Cal now requires prior authorization for developmental screening CPT code 96110 for ages 6-20 starting November 10, 2020, and will deny claims for ages 21 and older. Ages 0-5 remain no prior auth required with twice yearly frequency limits.
Action Required
Immediately: Billing team must update system to require prior authorization for CPT 96110 developmental screening for patients ages 6-20 in Fresno, Kings and Madera counties Medi-Cal. Stop billing CPT 96110 for patients 21 and older as claims will be denied. For ages 0-5, continue billing without modifier KX up to twice per year. For autism screening at any age, use CPT 96110 with modifier KX. Update encounter forms to remind providers of age-based requirements.