Expanded Reimbursement To Population For Adverse Childhood Experiences Screening

TO: BEHAVIORAL HEALTH PARTICIPATING AND NON-PARTICIPATING PROVIDERS

IMPACTED PLANS: MAINSTREAM MEDICAID, HIV SNP, and HARP

Dear MetroPlusHealth Provider:

Effective January 1, 2025, per updated mandate issued by New York State Department of Health (NYSDOH), MetroPlusHealth will expand coverage and reimbursement for Adverse Childhood Experiences (ACEs) screenings conducted in primary care settings when provided to adults 21 years to 65 years of age.

Please refer to our previous memo of State issued coverage and billing guidelines for children up to 21 years in Medicaid and HIV SNP plans at Reimbursement-for-Adverse-Childhood-Experiences-Screening-Memo_FINAL.pdf (metroplus.org).

Billing Guidelines and Criteria:

  • Coverage of ACEs screening is limited to once per lifetime for adults 21 years to 65 years of age.
  • Screening for ACEs is always voluntary, to minimize the risk of retraumatizing the individual.
  • Please Note: Annual ACEs screening will continue to be covered for children and adolescents up to 21 years of age in Mainstream and HIV SNP, as determined appropriate and medically necessary.

Providers are expected to make referrals to appropriate resources, such as mental health providers or community-based organizations, for any needs identified or requested as the result of the screening.

Approved Providers:

  • Physicians
  • Nurse Practitioners (NPs)
  • Ordered Ambulatory:
    • Clinic
    • Hospital Outpatient Department (HOPD)
    • FQHCs – ACEs Screening is included within the Prospective Payment System (PPS) primary care rate.

Licensed, or unlicensed staff under the supervision of a licensed provider, with experience in trauma-informed care can bill for screening, in accordance with Medicaid guidelines.

Billing Codes:

 

Procedure CodeModifiersDescriptionAllowance Per NYS Medicaid Member
G9919U1 and U9ACEs screening was performed, and positive*, provision of recommendations is used for high-risk patients.One lifetime screen only for adults 21 years of age to 65 years of age.
G9920U1 and U9ACES screening was performed and negative.One lifetime screen only for adults 21 years of age to 65 years of age.

*Billing and coding are based solely on the total ACEs score.

Please see DOH Referenced Sources here:

If you have any questions regarding this memo, please contact MetroPlusHealth at: [email protected].

> View and Download the Memo

last updated: January 24, 2025

Ready to Join Us?

Talk to us about questions or concerns

Monday–Saturday | 8 a.m.–8 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)

Already A Member?

Talk to us about any questions or concerns

Monday–Saturday | 8 a.m.–6 p.m. (ET)
Sunday | 9 a.m.–5 p.m. (ET)