22-1076 ECM Services Won't Need Prior Authorization in 2023

Date: 12/16/22

This service is removed from the prior authorization list effective January 1, 2023

Enhanced care management codes for physician care oversight (G9008) and for other specified case management (G9012) will not require prior authorization (PA) for dates of service starting on January 1, 2023.

As a reminder, 1 unit equals 1 hour.

Referral Process

There is no change to the referral process. Providers should continue to refer members for ECM through the standard process.

Check the prior authorization list often

Refer to the prior authorization list to see if a service requires it. The list is revised during the year.

Go to the web for resources

More information about prior authorizations and referral forms can be found in the Prior Authorizations. Then choose a topic.

Additional information

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.