MedicaidReimbursementMedium impact
20-180 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
Health Net California now offers supplemental payments of $59.90 for developmental screenings using CPT code 96110 (without modifier KX) for Medi-Cal members under age 21 in specific counties. Prior authorization is not required, but providers must use standardized screening tools and maintain detailed documentation.
Action Required
Immediately: Billing team must ensure CPT code 96110 is billed WITHOUT modifier KX for developmental screenings to qualify for $59.90 supplemental payments. Submit current W-9 form with rendering physician's TIN and NPI to HNCA_W9_Submissions@Centene.com (subject: Prop 56 W9) or fax to 1-833-794-0423. Providers must document screening tool used, results, interpretation, discussion with family, and actions taken in medical record. Submit clean claims within one year of service date.