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Medi-CalMedicaid · Coverage · Specialty Services · CAHigh impact

Reminder: Policy Clarifications for Covered Medi-Cal CHW Services

Act
immediately
Effective date
Not stated in the notice
Identified
Sep 1, 2026

Summary

DHCS has published clarifications on Medi-Cal coverage for Community Health Worker (CHW) services, specifically addressing billing requirements for individual services (CPT 98960, HCPCS G0019/G0022) and group services (CPT 98961/98962), telehealth modality use, and health navigation services. The policy emphasizes that CHWs may now assist members with maintaining Medi-Cal enrollment and enrollment in related assistance programs (CalWORKs, CalFRESH) as part of covered health navigation services.

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What to do

immediately · 8 steps
01Billing team must review the Medi-Cal Provider Manual's Community Health Worker Preventive Services section to ensure accurate coding and billing practices.
02Individual CHW services use correct codes (CPT 98960 for individual sessions or HCPCS G0019/G0022 where applicable).
03Group CHW services use CPT 98961/98962.
04Telehealth modalities are billed appropriately per policy.
05Update billing guidelines and staff training documentation.
06Ensure that claims for health navigation services now include support for Medi-Cal enrollment maintenance and related assistance program enrollment (CalWORKs, CalFRESH).
07Review existing CHW billing practices to identify and correct any non-compliant claims.
08Communicate changes to providers and CHW staff to prevent future claim denials.

Codes mentioned

989609896198962G0019G0022

Original notice

Reminder: Policy Clarifications for Covered Medi-Cal CHW Services
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
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Related changes

See all Medi-Cal changes →
Coming Soon: Important Policy Reminders and Clarifications for Covered Medi-Cal CHW ServicesMediumNo effective date · Specialty ServicesReimbursement Rates for CHW HCPCS Codes G0019 and G0022HighEffective Apr 1, 2025 · Claims & BillingClarification to Existing Community Health Worker (CHW) Preventive Services PolicyMediumEffective Jun 26, 2026 · Specialty ServicesBrowse every Medi-Cal change in the policy list

Related policy hubs

Medi-Cal policiesCA policy changesCode 98960Code 98961Code 98962Code G0019Code G0022

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