Care-Based Incentive (CBI) Summary

The Central California Alliance for Health CBI program is comprised of a set of measures to encourage preventive health services and connect Medi-Cal members with their primary care providers (PCPs).

The CBI program consists of provider incentives that are paid to qualifying contracted provider sites, including family practice, pediatrics and internal medicine. Provider incentives are broken into:

Programmatic measures which are paid annually based on the rate of performance in each measure.
Fee-for-service (FFS) measures which are paid quarterly when a specific service is performed or a measure is achieved.

This incentive summary provides an overview of the CBI program. For more information about provider incentive payments, refer to the CBI Programmatic Measure Benchmarks and the Alliance Provider Manual.

For additional information on the CBI Program, refer to the program year 2024 and 2025 CBI Technical Specifications. For general questions, contact your Provider Relations Representative or call Provider Relations at 800-700-3874, ext. 5504.

2026 Summary of Changes

New programmatic measures

The Controlling High Blood Pressure measure moved from exploratory to programmatic and measures members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) during the measurement year.

The BP reading must occur on or after the date of the second HTN diagnosis.

Measure changes

The Application of Dental Fluoride Varnish measure now requires at least two topical fluoride applications by the end of the CBI program year and co-located dental practices at Federally Qualified Health Centers (FQHCs) can now submit dental data via the Data Submission Tool.
The Breast Cancer Screening measure now measures members 40-74 years of age who were recommended for routine breast cancer screening and had a mammogram to screen for breast cancer. The measure also includes gender-affirming codes that can be submitted via the Data Submission Tool.
The Child and Adolescent Well-Care Visits, Well-Child Visits in the First 15 Months, and Well-Child Visits for Age 15 Months-30 Months of Life measures removed telehealth visits from each of the measure numerators.
The Immunizations: Adolescents measure now includes the pentavalent meningococcal vaccine for numerator compliance and the age for MCV now begins at 10 years of age.
The Social Determinants of Health (SDOH) ICD-10 Z Code Submission
fee-for-service measure now accepts all DHCS SDOH ICD-10 Z Codes (All Plan Letter 21-009) and providers now qualify for a $100 payment per member, per provider federal tax ID, per ICD-10 diagnosis code, with a limit of $7,500 per tax ID within the CBI program year.

Coding changes

The Cervical Cancer Screening measure now includes self-collected HPV testing (87626) and removes in-office pap collection code Q0091. LOINC codes for sex assigned at birth (LOINC code 76689-9) are added, which can exclude members from the measure if the sex assigned at birth (LOINC code 76689-9) is submitted with male (LOINC code LA2-8).
The Chlamydia Screening measure (previously Chlamydia Screening in Women) accepts LOINC codes for sex assigned at birth, which can exclude members from the measure if the sex assigned at birth (LOINC code 76689-9) is submitted with male (LOINC code LA2-8) or include members if sex assigned at birth (LOINC code 76689-9) is submitted with female (LA-3).
The Breast Cancer Screening measure added LOINC codes for sex assigned at birth (LOINC code 76689-9), which can include members if the sex assigned at birth (LOINC code 76689-9) is submitted with female (LOINC code LA3-6).

2025 Summary of Changes

New Programmatic Measures

The following measures were moved from exploratory to programmatic measures:

Chlamydia Screening in Women.
Colorectal Cancer Screening.
Well-Child Visits for Age 15 Months–30 Months of Life.

Measure Changes

Diabetic HbA1c Poor Control >9% changed to Diabetic Poor Control >9%. The measure was modified to review the most recent glycemic status received through hemoglobin A1c [HbA1c] or glucose management indicator [GMI] testing.

Post-Discharge Care

This measure was updated to:

Accept follow-up care by specialists.
Exclude members that were admitted to a Skilled Nursing Facility (SNF) on the same day of discharge.

Preventable Emergency Visits

This measure was updated to remove urgent care visits.

Point Allocation Changes

Total allowable points for Quality of Care measures changed from 38 points to 53 points.

Retired Measures

Health Equity: Child and Adolescent Well-Care Visit.
Performance Improvement Measure.

Programmatic

Care Coordination Measures - Access Measures
Measure	Summary Definition	Member Eligibility	Resources	Points Possible: 21.5
Adverse Childhood Experiences (ACEs) Screening in Children and Adolescents	The percentage of members one to 20 years of age who are screened for Adverse Childhood Experiences (ACEs) annually using a standardized screening tool.	≥5 Eligible Linked Members	Adverse Childhood Experiences (ACEs) in Children and Adolescents Tip Sheet ACE Screening HCPCS codes: G9919 - Screening performed – results positive and provision of recommendations provided G9920 - Screening performed – results negative	3
Application of Dental Fluoride Varnish**	The percentage of members six months to five years of age (up to before their sixth birthday) who received at least two topical fluoride applications by staff at the PCP office and/or co-located dental practices at Federally Qualified Health Centers (FQHCs) during the measurement year.	≥5 Eligible Linked Members	Application of Dental Fluoride Varnish Tip Sheet Fluoride Application codes: CPT code: 99188 CDT codes (FQHC with dental practices; DST submission only): D1206, D1208	2
Developmental Screening in the First Three Years	The percentage of members one to three years of age screened for risk of developmental, behavioral and social delays using a standardized screening tool in the 12 months preceding, or on their first, second or third birthday.	≥5 Eligible Linked Members	Developmental Screening in the First Three Years Tip Sheet Developmental Screening CPT code: 96110	2
Initial Health Appointment	New members who receive a comprehensive initial health appointment (IHA) within 120 days of enrollment with the Alliance.	≥5 eligible linked members continuously enrolled within 120 days of enrollment (four months)	DHCS MMCD Policy Letter 22-030 For a full list of codes, see the Initial Health Appointment Tip Sheet.	4
Post-Discharge Care	Members who receive a post-discharge visit within 14 days of discharge from a hospital inpatient stay by a linked primary care provider (PCP) or specialist. This measure pertains to acute hospital discharges only. Emergency room visits do not qualify.	≥5 Eligible Linked Members	Post-Discharge Care Tip Sheet Post-Discharge CPT Codes: 99202-99215, 99241-99245, 99341- 99350, 99381-99385, 99391-99395, 99429	10.5
Care Coordination Measures – Hospital and Outpatient Measures
Measure	Summary Definition	Member Eligibility	Resources	Points Possible: 25.5
Ambulatory Care Sensitive Admissions	The rate of ambulatory care sensitive admissions per 1,000 eligible members per year. The list of conditions is based on plan-identified AHRQ specifications. *Note:* This is an inverse measure; a lower rate of admissions qualifies for more CBI points.	≥100 Eligible Linked Members	Ambulatory Care Sensitive Admissions Tip Sheet For a full list of codes see the CBI Technical Specifications	7
Plan All-Cause Readmission	The number of members 18 years of age and older with acute inpatient and observation stays during the measurement year that was followed by an unplanned acute readmission for any diagnosis within 30 days. *Note:* This is an inverse measure; a lower rate of readmissions qualifies for more CBI points.	≥100 Eligible Linked Members	Plan All-Cause Readmission Tip Sheet For a full list of codes see the CBI Technical Specifications	10.5
Preventable Emergency Visits	The rate of preventable emergency department (ED) visits per 1,000 eligible members per year. *Note:* This is an inverse measure; a lower rate of preventable ED visits qualifies for more CBI points.	≥100 Eligible Linked Members	Preventable Emergency Visits Tip Sheet Preventable Emergency Visit Diagnosis Tip Sheet	8
Quality of Care Measures
Measure	Summary Definition	Member Eligibility	Resources	Points Possible: 53
Breast Cancer Screening**	The percentage of members 40-74 years of age who were recommended for routine breast cancer screening and had a mammogram to screen for breast cancer on or between October 1 two years prior to the measurement period and the end of the measurement period.	≥30 Eligible Linked Members	Breast Cancer Screening Tip Sheet Breast Cancer Screening CPT Codes: 77061-77067 For a full list of codes see the CBI Technical Specifications	Varies
Cervical Cancer Screening	The percentage of members 21-64 years of age who were recommended for routine cervical cancer screening and were screened for cervical cancer using *any* of the following criteria: Members 21-64 years of age who had cervical cytology performed within the last three years. Members 30-64 years of age who had cervical high-risk human papillomavirus (hrHPV) testing within the last five years. Members 30-64 years of age who had cervical cytology/hrHPV cotesting within the last five years. Note: When testing for hrHPV or cotesting for cervical cancer, members must be 30-64 years of age or older on the date of the test.	≥30 Eligible Linked Members	Cervical Cancer Screening Tip Sheet Cervical Cytology CPT codes: 88141-88143, 88147-88150, 88152-88153, 88164-88167, 88174-88175 hrHPV CPT codes: 87624-87626 hrHPV HCPCS code: G0476 To exclude members from the measure: Z90.710 - absence of both cervix and uterus Z90.712 - absence of cervix with remaining uterus Q51.5 - agenesis and aplasia of cervix (can be used for a male-to-female transgender person) Sex assigned at birth (DST submission only): Sex Assigned at Birth (LOINC code 76689-9) of Male (LOINC code LA2-8) For a full list of codes see the CBI Technical Specifications	Varies
Child and Adolescent Well-Care Visits (Three to 21 years)**	The percentage of members three to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.	≥30 Eligible Linked Members	Child and Adolescent Well-Care Visits Tip Sheet Well-Visit codes: CPT codes: 99382-99385, 99392-99395 ICD-10 codes: Z00.00-Z00.01, Z00.121-Z00.129, Z01.411, Z01.419, Z00.2, Z00.3, Z02.5, Z76.2	Varies
Chlamydia Screening**	The percentage of members 16-24 years of age who were recommended for routine chlamydia screening, identified as sexually active and had at least one test for chlamydia during the measurement year.	≥30 Eligible Linked Members	Chlamydia Screening Tip Sheet Chlamydia Screening CPT codes: 87110, 87270, 87320, 87490-87492, 87810 Sex assigned at birth LOINC codes (DST submission only): Sex assigned at birth (76689-9) of male (LA2-8)	Varies
Colorectal Cancer Screening*	The percentage of members 45-75 years of age who had appropriate screening for colorectal cancer. For members 46-75 years of age, use *any* of the following criteria: Fecal occult blood test within the last year. Flexible sigmoidoscopy within the last five Colonoscopy within the last ten years CT colonography within the last five Stool DNA (sDNA) with FIT test within the last three years.	≥30 Eligible Linked Members	Colorectal Cancer Screening Tip Sheet Fecal occult blood test CPT codes: 82270, 82274 Flexible sigmoidoscopy CPT codes: 45330-45335, 45337, 45338, 45340-45342, 45346, 45347, 45349, 45350 Colonoscopy CPT codes: 44388-44394, 44401-44408, 45378-45382, 45384-45386, 45388-45393, 45398 CT colonography CPT codes: 74261-74263 Stool DNA (sDNA) with FIT CPT code: 81528	Varies
Controlling High Blood Pressure*	The percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) during the measurement year. BP reading must occur on or after the date of the second HTN diagnosis.	≥30 Eligible Linked Members	Controlling High Blood Pressure Tip Sheet Controlling High Blood Pressure Codes: Systolic CPT II codes: 3074F, 3075F 3077F Diastolic CPT II codes: 3078F, 3079F, 3080F
Depression Screening for Adolescents and Adults	The percentage of members 12 years of age and older who are screened for clinical depression using an age-appropriate standardized tool, performed between January 1 and December 1 of the measurement period.	≥30 Eligible Linked Members	Depression Screening for Adolescents and Adults Tip Sheet Depression Screening Tool LOINC codes (DST submission only; must include result): Pediatric: 89205-9, 89204-2 Adult: 89209-1, 89205-5, 90853-3, 48545-8, 48544-1, 90221-3, 71777-7 Pediatric & Adult: 89208-3, 55758-7, 44261-6, 71965-8, 99046-5	Varies
Diabetic Poor Control >9%	The percentage of members 18-75 years of age with diabetes (type 1 and type 2) whose most recent glycemic assessment (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was >9% in the measurement year. The measure goal is for members to be non-compliant by having an HbA1c or GMI of equal to or less than 9% and being in good control (a lower rate indicates better performance). Members with no lab or no lab value submitted, a claim without an HbA1c value or an HbA1c value >9% is considered compliant for this measure.	≥30 Eligible Linked Members	Diabetic HbA1c Poor Control >9% Tip Sheet CPT codes: 83036, 83037 (Non Medi-Cal benefit code) LOINC codes: 17855-8, 17856-6, 4548-4, 4549-2, 96595-4, 97506-0 CPT II result codes (Point of Service Labs): 3044F, 3046F, 3051F, 3052F	Varies
Immunizations: Adolescents**	The percentage of adolescents 13 years of age who had one dose of meningococcal vaccine, one dose of tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccine and completed the human papillomavirus (HPV) vaccine series by their 13th birthday.	≥30 eligible linked members	Immunizations: Adolescents Tip Sheet Immunization CPT Codes: Meningococcal – 90619, 90733, 90734 Tdap – 90715 HPV – 90649, 90650, 90651	Varies
Immunizations: Children (Combo 10)	The percentage of children who received *all* of the following 10 vaccines by their second birthday: Three HepB (first dose 0-4 weeks of age), history of hepatitis B vaccine or anaphylaxis due to the vaccine. Four DTaP (first dose 42 days or more after birth) or anaphylaxis or encephalitis due to the vaccine. Three IPV (first dose 42 days or more after birth) or anaphylaxis due to the vaccine. Three Hib (first dose 42 days or more after birth) or anaphylaxis due to the vaccine. Four PCV (first dose 42 days or more after birth) or anaphylaxis due to the vaccine. Two or three RV, depending on vaccine type (first dose 42 days or more after birth and before 15 weeks of age). The full series must be completed by eight months of age. Members with anaphylaxis due to the vaccine may be excluded. Two flu (first dose 180 days or more after birth) or anaphylaxis due to the vaccine. One MMR (on or between child’s first and second birthday), history of measles, mumps and rubella illness or anaphylaxis due to the vaccine. One VZV (on or between the child’s first and second birthday), history of varicella zoster (chicken pox) illness or anaphylaxis due to the vaccine. One Hep A (on or between the child’s first and second birthday), history of hepatitis A illness or anaphylaxis due to the vaccine.	≥30 Eligible Linked Members	Immunizations: Children (Combo 10) Tip Sheet For a full list of codes see the CBI Technical Specifications	Varies
Lead Screening in Children	The percentage of children two years of age who had one or more capillary or venous lead blood test for lead poisoning by their second birthday	≥30 Eligible Linked Members	Lead Screening in Children Tip Sheet Lead Screening CPT code: 83655 For a full list of codes see the CBI Tech Specs.	Varies
Well-Child Visits in the First 15 Months**	The percentage of members 15 months of age who had six or more well-child visits with a PCP during the first 15 months of life.	≥30 Eligible Linked Members	Well-Child Visits in the First 15 Months Tip Sheet Well-Child Visit codes: CPT codes: 99381, 99382, 99391, 99392, 99461 ICD-10 codes: Z00.110, Z00.111, Z00.121, Z00.129, Z00.2 Z02.5, Z76.1, Z76.2, Z02.84	Varies
Well-Child Visits for Age 15 Months-30 Months of Life	The percentage of members 30 months of age who had two or more well-child visits with a PCP between the child’s 15-month birthday plus one day and the 30-month birthday.	≥30 Eligible Linked Members	Well-Child Visits for Age 15 Months-30 Months of Life Tip Sheet Well-Child Visit codes: CPT codes: 99382, 99392, 99461 ICD-10 codes: Z00.121, Z00.129, Z00.2, Z76.1, Z76.2, Z02.5, Z02.84	Varies

* New measure for 2026 ** Measure change for 2026

Fee-for-service

Practice Management Measures
Measure	Summary Definition	Resources
Adverse Childhood Experiences (ACEs) Training and Attestation	Plan pays providers, which includes mid-level providers, for completing the DHCS ACEs training and attestation. The plan pays $200 to each group that the provider practices under.	$200 one-time payment after receipt of state notification of training and attestation completion. Payments do not reoccur yearly or quarterly. CBI Technical Specifications
Behavioral Health Integration	Plan pays a $1,000 one-time payment to providers for achievement of NCQA Distinction in Behavioral Health Integration. Payments are made a single time after distinction is received by the Alliance.	$1,000 one-time payment for achievement of NCQA Distinction in Behavioral Health Integration. Payments do not reoccur yearly or quarterly. CBI Technical Specifications
Cognitive Health Assessment Training and Attestation	Plan pays providers, which includes mid-level providers, for completing the DHCS cognitive health assessment training and attestation. The plan pays each group $200 that the provider practices under.	$200 one-time payment after receipt of state notification of training and attestation completion. Payments do not reoccur yearly or quarterly. CBI Technical Specifications
Diagnostic Accuracy and Completeness Training	Plan pays providers for completing the CMS Diagnostic Accuracy and Completeness Training.	$200 one-time payment after receipt of certification notification of training completion. Payments do not reoccur yearly or quarterly. CBI Technical Specifications
Quality Performance Improvement Projects	Plan pays providers $1,000 for each office that completes an Alliance-offered Quality Performance Improvement Project. Only offices with metrics below the minimum performance level, measured at the 50th percentile for the 2025-year programmatic payment are eligible for payment for completion of Quality Performance Improvement Projects.	$1,000 one-time payment after notification of project completion. Payments do not reoccur yearly or quarterly. CBI Technical Specifications
Patient-Centered Medical Home (PCMH) Recognition	Plan pays a one-time payment of $2,500 to providers for achievement of NCQA recognition or The Joint Commission (TJC) certification. A copy of the recognition/certification must be received by the Alliance.	$2,500 one-time payment. Payments do not occur yearly or quarterly. For providers submitting their initial application for NCQA PCMH Recognition, use Alliance discount code CCAAHA to save 20% on your initial application fee. CBI Technical Specifications
Social Determinants of Health (SDOH) ICD-10 Z Code Submission**	Plan pays PCPs who submit claims using the DHCS SDOH ICD-10 Z Codes (All Plan Letter 21-009). Providers qualify for a $100 payment per member, per provider federal tax ID (EIN), per ICD-10 diagnosis code for claim submissions with a DHCS SDOH Z diagnosis code, not to exceed $7,500 per tax ID within the CBI term.	$100 per member, per provider federal tax ID (EIN), per ICD-10 diagnosis code for claim submissions with a DHCS SDOH Z diagnosis code, not to exceed $7,500 per tax ID within the CBI term. Social Determinants of Health Tip Sheet CBI Technical Specifications

* New measure for 2026 ** Measure change for 2026

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