Billing procedures for physical health Targeted Case Management (TCM) services
Targeted Case Management (TCM) services support juveniles transitioning from carceral settings back into their communities. TCM services are available within 30 days prior to release and for at least 30 days following release. These services promote continuity of care and ensure access to needed medical, educational, and social supports.
Eligible juveniles may receive TCM services to address medical, social, educational, and health-related social needs within the community where they will reside after release.
Billing GHP Family
As of October 12, 2025, the Pennsylvania Department of Human Services opened procedure code G9012 for use in billing TCM services rendered to juvenile Medical Assistance enrollees pre and post release from a carceral setting.
When billing GHP Family for members in this circumstance, use procedure code G9012 with a TF modifier. It is important to remember to include the TF modifier when billing for these services. Without the TF modifier, your GHP Family claims may not process correctly.
GHP Family only handles claims for the physical health TCM services provided to members. Behavioral health TCM services should be addressed through the member’s county-based Behavioral Health Managed Care Organizations (BH-MCO).
Covered TCM activities
TCM services include:
- Comprehensive assessment and periodic reassessment to determine needed services across medical, educational, social, or other domains.
- Development and revision of a person-centered care plan based on assessment findings.
- Referral and linkage activities, such as scheduling appointments and connecting individuals with community providers or programs.
- Monitoring and follow-up, including contact with the individual, family members, or providers to ensure the care plan is implemented appropriately. At least one annual monitoring contact is required.
Member eligibility
Eligible individuals include:
- Youth under age 21 enrolled in Medicaid
- Ages 17 or younger
- Ages up to 21 if enrolled in special education
- Former foster youth
- Ages 17–26
Service timelines
- Pre-release: Up to 30 days before release
- Post-release: At least 30 days after release
