MedicaidReimbursementMedium impact
20-222 Prop 56 Payments for Family Planning
Health Net·CA · Family Medicine, OB-GYN, Urology·Prior Authorization
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Summary
CalViva Health in Fresno, Kings and Madera counties will provide supplemental Proposition 56 payments for family planning services to qualified Medi-Cal providers. These fixed-rate payments are in addition to standard Medi-Cal reimbursement for specific contraceptive, sterilization, and pregnancy testing services.
Action Required
Immediately: Billing team must ensure W-9 forms are current (within 12 months) and include TIN and NPI information. Submit to HNCA_W9_Submissions@Centene.com with 'Prop 56 W9' in subject line. Update billing system to flag qualifying family planning CPT codes for supplemental payment tracking. File clean claims within one year of service date. Note that CPT codes 11976, 11981, 58300, 58301, 55250, 58340, 58555, 58565, 58600, 58615, 58661, 58670, 58671, and 58700 with modifiers UA or UB are excluded from supplemental payments.