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MedicaidReimbursementMedium impact

20-026 Prop 56 Rates Extended for SFY 2019-2021

Health Net·CA · Family Medicine, Internal Medicine, General Practice +2 more·Reimbursement
Effective date
Jul 1, 2019
We identified it
Jun 20, 2026
Days to comply

Summary

Proposition 56 supplemental payment rates for Medi-Cal physician services have been extended through December 31, 2021, maintaining the same rates as SFY 2018-2019. These supplemental payments apply to specific CPT codes for office visits, preventive care, and psychiatric services in seven California counties.

Action Required

Action needed
Immediately: Billing team must ensure current W-9 forms are on file for all providers to receive Prop 56 supplemental payments. Submit W-9 forms to HNCA_W9_Submissions@CENTENE.COM with 'Prop 56 W9' in subject line or fax to 1-833-794-0423. Verify claims are submitted with qualifying CPT codes for Medi-Cal patients in Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties. Supplemental payments will be made within 90 days of clean claims.

Affected Billing Codes

90791
90792
90863
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99381
99382
99383
99384
99385
99391
99392
99393
99394
99395