Summary
Molina Care Connections expands telehealth and in-person nurse practitioner services across 22 states with open scheduling for preventive care and chronic condition management. Developmental screening requirements for children ages 1-3 now mandate use of standardized global screening tools (CPT 96110) with specific documentation; domain-specific tools (M-CHAT, ASQ:SE) are no longer billable for this measure. Utilization management criteria and processes remain unchanged but are clarified for provider reference.
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What to do
Action · 7 steps
01REQUIREMENTS: By Q2 2026 (April 1 effective).
02Billing team must update billing system to ensure CPT 96110 is only submitted when global standardized screening tools (ASQ, PEDS) are documented—reject claims using 96110 with domain-specific tools (M-CHAT, ASQ:SE) before submission.
03Providers and front desk must update well-child visit encounter forms and EMR templates to require documentation of: tool name, screening date, score/result, clinical interpretation, and recommendations/follow-up.
04Coding staff must validate all developmental screening claims use ICD-10 Z13.42 (global developmental delays) or Z00.129 (routine child health exam without abnormal findings) exclusively.
05Educate clinical staff that claims using CPT 96110 for domain-specific tools will not count toward DEV-CH measure and may be denied.
06Consequence: Non-compliant claims will be denied and practice will miss HEDIS quality measure targets.
07Contact Provider Relations Representative for implementation support.
Codes mentioned
96110Z13.42Z00.129
Original notice
PDF Version
molinahealthcare.com · Always check the source before changing claims.
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