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Geisinger Health PlanMedicaid · Billing Codes · Claims · PA · Pediatrics, General PracticeHigh impact

Billing procedures for physical health Targeted Case Management (TCM) services

Act
by Oct 12, 2025
Effective date
Oct 12, 2025
Identified
Jul 29, 2026

Summary

Effective October 12, 2025, Pennsylvania Medicaid (GHP Family) now covers Targeted Case Management (TCM) services for juveniles transitioning from carceral settings using procedure code G9012 with mandatory TF modifier. Billing team must use G9012 + TF modifier for all physical health TCM claims; claims without the TF modifier will not process correctly. Behavioral health TCM services route to county-based BH-MCOs separately.

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What to do

by Oct 12, 2025 · 5 steps
01Billing team must update billing system to recognize and require procedure code G9012 with TF modifier for all GHP Family TCM claims involving eligible juveniles pre- and post-release from carceral settings.
02Add system edits to flag claims submitted with G9012 missing the TF modifier and reject them before submission.
03Update provider education materials and billing guidance documents to emphasize mandatory TF modifier inclusion.
04Train all billing staff on eligible populations (youth under 21 in Medicaid, ages 17 or younger, up to 21 if in special education, former foster youth ages 17-26, and service windows: up to 30 days pre-release and at least 30 days post-release).
05Route all behavioral health TCM inquiries to county BH-MCOs.
If missed: Failure to include TF modifier will result in claim denial and reprocessing delays.

Codes mentioned

G9012

Original notice

Billing procedures for physical health Targeted Case Management (TCM) services
geisinger.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Geisinger Health Plan policiesPA policy changesPediatricsGeneral PracticeCode G9012

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