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MedicaidDocumentationMedium impact

Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members

L.A. Care Health Plan·CA · Family Medicine, Internal Medicine, General Practice +2 more·Provider Communication
Effective date
May 21, 2024
We identified it
Jun 20, 2026
Days to comply

Summary

L.A. Care Health Plan requires Initial Health Appointments (IHA) for newly enrolled Medi-Cal members to be completed within 120 days of enrollment. Providers must document comprehensive health assessments and use specific billing codes, with monthly reporting available through the Provider Portal to track compliance.

Action Required

Action needed
Immediately: Billing team must ensure proper documentation of all IHA components in member medical records and use appropriate CPT/ICD-10 codes from the provided list when billing for newly enrolled L.A. Care Medi-Cal members. Access monthly IHA reports through Provider Portal to track members requiring appointments within 120 days. Document all member outreach attempts and refusals in charts for compliance auditing.

Affected Billing Codes

Z00.00
Z00.01
Z00.1
Z00.11
Z00.12
Z00.121
Z00.129
Z00.8
Z71.89
Z34.90
Z34.91
Z34.92
Z34.93
59400
59425
59426
59510
59610
59618
96156
96158
96159
96164
96165
99203
99204
99205
99213
99214
99215
99244
99245
99304
99305
99306
99460
99461
99463
G0466
G0467
G0468
G0469
G0470