MedicaidReimbursementMedium impact
20-181 Prop 56 Payments for Developmental Screenings
Health Net·CA · Pediatrics, Family Medicine·Prior Authorization
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Medi-Cal in Fresno, Kings and Madera counties now provides supplemental payments of $59.90 for developmental screenings using CPT 96110 without modifier KX. Prior authorization is not required for these screenings, but providers must use standardized tools and maintain specific documentation to qualify for payments.
Action Required
Immediately: Billing team must ensure W-9 forms are on file by emailing HNCA_W9_Submissions@Centene.com or faxing to 1-833-794-0423. For developmental screenings, bill CPT 96110 without modifier KX (modifier KX disqualifies for supplemental payment). Providers must document the screening tool used, results, interpretation, discussion with family, and actions taken in medical records. Submit claims within one year of service date to receive $59.90 supplemental payment.