CalAIM ECM Billing Codes in 2026: G9008, G9012, G9007 and the Modifier Rules That Decide Whether You Get Paid
August 21, 2026
Quick summary: ECM services are defined by a HCPCS code and a modifier together — never the code alone. DHCS updated its coding guidance in January 2026 (version 1.31), and the most important line in it for providers is this: managed care plans may not require or allow you to use any codes or modifiers beyond the DHCS-established set, even if you and the plan both agree to it. If your MCP is asking for a code that isn't on the DHCS list, that's a problem worth raising.
The rule most ECM providers learn the hard way
A billing manager submits a clean-looking claim with HCPCS code G9008. The plan rejects it. The service was delivered, documented, and authorized — but the claim was never an ECM claim in the first place.
That's because under DHCS guidance, the code and modifier combined are what define the service. G9008 on its own is just a coordinated care fee. G9008 with modifier U1 is Enhanced Care Management delivered in person by clinical staff. One missing character on the claim line is the difference between a paid encounter and a rejection.
This trips up new ECM providers constantly, especially organizations that came into ECM from grant-funded case management, where nobody had to think about modifiers at all.
The full ECM code set
DHCS uses three HCPCS codes for ECM. Everything else is modifiers.
ECM delivered by clinical staff — G9008
| Modifier | What it means | |---|---| | U1 | ECM in person, provided by clinical staff | | U1, GQ | ECM by phone or telehealth, provided by clinical staff | | U8 | A single in-person outreach attempt to initiate a member into ECM | | U8, GQ | A single telephonic or electronic outreach attempt to initiate a member into ECM |
DHCS defines clinical staff as someone qualified by licensure to perform ECM — LVN, LPN, RN, LCSW, PA, NP, CNS, or LMFT, among others. Note that certification is not licensure. A certified community health worker is non-clinical for coding purposes.
ECM delivered by non-clinical staff — G9012
| Modifier | What it means | |---|---| | U2 | ECM in person, provided by non-clinical staff | | U2, GQ | ECM by phone or telehealth, provided by non-clinical staff | | U8 | A single in-person outreach attempt to initiate a member into ECM | | U8, GQ | A single telephonic or electronic outreach attempt |
Non-clinical staff includes medical assistants, community health workers, promotoras de salud, and doulas. Importantly, DHCS is explicit that both clinical and non-clinical staff can serve as a member's Lead Care Manager. The clinical/non-clinical split exists so DHCS can track who is delivering the benefit — it is not a restriction on who can hold the LCM role.
Multidisciplinary team conference — G9007
G9007 is used when a team conference occurs between the member's ECM Lead Care Manager and one or more other providers involved in managing that member's care. It takes no modifier, because DHCS assumes clinical staff either initiated or participated in the conference.
This one is under-billed. Many ECM teams hold regular case conferences, document them thoroughly in a progress note, and never capture them as a distinct encounter.
The outreach codes are the most misunderstood part of the code set
The U8 outreach modifiers exist to capture the effort involved in initiating a member into ECM. Two details matter here.
First: unsuccessful attempts count. DHCS states that the outreach codes can be used to indicate both successful and unsuccessful outreach attempts. If your team called a member three times, knocked on a door, and left a note — those attempts are reportable.
Second: mass communication does not count. DHCS is direct about this. Mass mailings, distribution emails, and bulk text messages do not qualify as outreach and should not be reported. Individualized text messages or secure emails to a specific member do count as telephonic/electronic outreach.
The practical implication is that your documentation system needs to record outreach attempts as discrete, timestamped, per-member events with a modality attached — not as a note that says "attempted contact several times this week."
Telehealth: GQ is an addition, not a replacement
When an ECM service is delivered by phone or telehealth, GQ is added to the existing modifier. It does not replace U1 or U2. A non-clinical staff member conducting a telehealth ECM encounter bills G9012 with U2 and GQ. All telehealth must be delivered in accordance with DHCS telehealth policy.
What changed in the January 2026 update
DHCS published version 1.31 of the coding guidance in January 2026. Three things are worth flagging.
The codes are explicitly interim. DHCS added a notice that the current HCPCS codes and modifiers remain in use only until permanent codes are established. Build your configuration so codes are data, not hardcoded logic — you will be changing them.
Modifier meanings are program-specific. DHCS added language clarifying that because modifiers are used differently across DHCS programs, the guidance in this document defines modifier use specifically for ECM and Community Supports. If your organization also bills Regional Center services or another Medi-Cal program, do not assume a modifier carries the same meaning across them.
New Community Supports subservice codes were added. If you deliver Community Supports alongside ECM, the January 2026 update introduced coding for newly defined and distinct subservices — particularly across the food and nutrition benefit. That is worth a separate review.
The rule that protects you from MCP-specific code requirements
This is the provision most ECM providers don't know exists, and it is the one that saves the most administrative pain.
DHCS states that MCPs may not require or allow ECM and Community Supports providers to report codes or modifiers beyond those in the guidance — even if the MCP and the provider mutually agree to the additional codes or modifiers. DHCS has said it is working individually with plans that were still requiring or allowing extra codes.
There is a related point on payment models. A plan can pay you however it wants — including PMPM. But regardless of the payment arrangement, the plan must still require the underlying services to be reported using the DHCS code and modifier set on a standard per-diem basis. A PMPM contract does not exempt you from encounter-level reporting.
And if your organization genuinely cannot produce compliant claims, DHCS allows an invoice pathway: providers may submit invoices to the MCP containing the minimum necessary data elements defined in the ECM and Community Supports Billing and Invoicing Guidance, and the MCP is responsible for translating those invoices into compliant encounters.
That invoice pathway is a safety valve, not a strategy. Plans translate invoices on their own timeline and with their own interpretation, and you lose visibility into what was actually submitted on your behalf.
What this means for how you run documentation
Every requirement above is really a documentation requirement wearing a billing costume:
- Staff type must be attached to the encounter, because it determines G9008 versus G9012. If your system records "who documented this" but not "were they licensed," you cannot code accurately without a manual lookup.
- Modality must be captured at the encounter level, because it determines whether GQ applies.
- Outreach attempts need to be first-class records — per member, per attempt, with modality and outcome — not free-text notes.
- Team conferences need to be a distinct encounter type, or G9007 goes unbilled.
- Codes need to be configurable per contract, because DHCS has told you these codes are temporary.
The organizations that struggle are almost never the ones with bad care managers. They are the ones where documentation lives in one system, authorizations live in a spreadsheet, and someone reconstructs billable encounters at month end from notes that were never structured for it.
Where CareAutomate fits
CareAutomate is an operations platform for Medicaid and HCBS providers. For ECM teams, the point is consolidation: intake, member profiles, care plans, encounter documentation, timestamped electronic signatures, and per-member unit tracking sit in one place, configured per contract with the codes and modifiers your plan actually uses — so your Lead Care Managers aren't waiting on anyone to tell them what they're allowed to record.
Because the documentation is structured at the point of service, the audit trail builds itself: who delivered the encounter, in what modality, when, and against which authorization. Encounter records convert into billing-ready output, including a compliant 837P file generated directly from documented service data, without a month-end reconstruction exercise.
If you're an ECM provider currently holding this together across a shared drive, a spreadsheet, and your MCP's portal, book a walkthrough and we'll show you what the same workflow looks like in one system.
This article summarizes DHCS's ECM and Community Supports HCPCS Coding Guidance (version 1.31, January 2026) and the CalAIM ECM Policy Guide (updated January 2026). Plan-specific requirements vary — always confirm against your MCP contract and the current DHCS guidance before changing your billing configuration.