MedicaidPrior AuthMedium impact
20-685 Age Limit Change for Developmental Screening with CPT Code 96110
Health Net·CA · Family Medicine, Pediatrics, Internal Medicine·Prior Authorization
Effective date
Nov 10, 2020
We identified it
Jun 20, 2026
Summary
Starting November 10, 2020, Medi-Cal now requires prior authorization for developmental screening using CPT 96110 for patients ages 6-20, while ages 0-5 remain without PA requirements. This supersedes previous guidance that didn't include PA requirements for this age group.
Action Required
Immediately: Billing team must update system to require prior authorization for CPT 96110 developmental screenings for patients ages 6-20 for Medi-Cal fee-for-service in specified California counties. Update encounter forms and train staff that ages 0-5 need no PA, ages 6-20 require PA, and ages 21+ will be denied. For autism screening, use CPT 96110 with modifier KX. Claims without proper PA for ages 6-20 will be denied.