You can bill Medi-Cal for the following services, as long as they are part of a member’s plan of care and meet Medi-Cal requirements:

• Health education
• Health navigation
• Screening and assessment
• Individual support and advocacy
• Asthma preventive services
• Violence prevention services

The following services cannot be billed to Medi-Cal under the CHW benefit:

• Services that require a license (like clinical case management)
• Child care or homemaker services
• Shopping or cooking meals
• Companion or employment services
• Helping someone enroll in non-health-related programs
• Medication or equipment delivery
• Respite care
• Duplicating services already provided by another Medi-Cal provider
• Transportation
• Services for people not enrolled in Medi-Cal (unless noted otherwise)

If you are working with multiple members of the same household:

• Before calling, check if other members share the same phone number
• Link all family members under the correct Group Code
• Prioritize calling an adult in the household
• Only submit a claim for household-level services (like food assistance)
• If supporting just one member (like for mental health), submit only for that person
• You must verify the identity of every household member you are claiming for

If you are supporting a minor member:

• Ask to speak with their parent or legal guardian
• Get the name and contact information of the guardian
• Verify the member’s identity through the guardian (full name, DOB, address)
• Get consent from the parent or legal guardian
• Document this information clearly in your case notes

Every billable interaction must include:

• A clear description of what happened (what, when, where, why, and how)
• Duration of the interaction
• Next steps and follow-up plan

Tip: Think of your notes like a SOAP note (Subjective, Objective, Assessment, Plan).

Document your interaction right after it happens. This ensures accuracy and supports timely claim submission.

Include Z-codes:
You can select 1–3 Z-codes that reflect the Social Determinants of Health (SDOH) addressed during the interaction.

Common Documentation Errors
Avoid these common issues that can lead to rejected claims:

• Missing or incorrect information (like DOB, CIN, or address)
• Incomplete or vague notes
• Using the wrong billing codes or modifiers

DHCS Example of documentation:

“Discussed the patient’s challenges accessing healthy food and options to improve the situation for 15 minutes. Assisted with the Supplemental Nutrition Assistance Program application for 30 minutes. Referred patient to [XYZ] food pantry.”

CHW services are billed in 30-minute increments, where 1 unit = 30 minutes of documented service. You may bill up to 4 units (2 hours) per member per day, for a maximum of 12 units per member overall - unless there is a signed Plan of Care on file (see next section for details).

Billing Codes:

Modifiers: 

If you provide more than 12 units of CHW services for a member, a licensed provider must complete a written Plan of Care.

The Plan of Care must:

• State the condition or need the service addresses
• List other providers involved
• Include written goals
• Define the specific CHW services and how often they’re needed
• Be reviewed and signed by a licensed provider
• Be reviewed every 6 months and cannot exceed 12 months

What You Should Do:

• Meet with your supervisor as soon as possible for any member who may need a Plan of Care.
• This will most often apply to Enhanced Care Management (ECM) graduates.
• Plan to complete the Plan of Care form by the time you reach 10 units of service to avoid delays in continued support.
• A Request for Authorization of Additional Units will be submitted through the Pear Suite platform.

For steps on submitting a Plan of Care or requesting additional units, see: Requesting Additional Units.