Adverse Childhood Experiences (ACEs) are potentially traumatic events in childhood, such as abuse, neglect, and household challenges. These events are strongly linked to long-term physical, mental, and behavioral health outcomes, including chronic disease, depression, substance use, and health-risk behaviors. Screening for ACEs in both pediatric and adult populations during routine wellness visits supports early identification of toxic stress, trauma-informed care, improved whole-person health outcomes, and strengthens patient-provider relationships.
Who can administer the ACEs screening?
- Screenings take about five minutes to complete and may be administered by trained staff (medical assistants, nursing staff, behavioral health or care coordination staff) or by licensed clinicians (MD/DO, NP, PA, LMFT, LCSW, PsyD, LPCC).
- Patients may complete the screening electronically or on paper. Licensed clinicians must review results and determine clinical risk/necessary next steps.
Providers should follow the ACEs Aware Tiered Clinical Response Framework:
- Low risk (ACE score 0-3 and no ACE-related health conditions): Reinforce protective factors and strengths, provide anticipatory guidance on stress and healthy development. Re-screen periodically as part of routine care, when applicable.
- Intermediate risk (ACE score 1-3 with ACE-related health conditions): Educate patients and families on the health effects of toxic stress, make targeted referrals to behavioral health and other community supports. Address ACE-associated conditions to prevent progression.
- High risk (Ace score >4 with or without ACE-related health conditions): Recognize high risk for toxic stress, refer promptly to trauma-informed mental health and social services. Coordinate care and follow-up.
Billing and Reimbursement
| Age | Screening Frequency | Validated Tool | HCPC Codes for both age groups |
| Children and Adolescents (0-21 years) | Annually, billable once per year | Pediatric ACEs and Related Life Events Screener (PEARLS). |
G9919 for a positive screen (ACE score 4 or greater). G9920 for a negative screen (ACE score 0–3). |
| Adults (21-64 years) | Once per adult lifetime *Dually enrolled members may be excluded. | Adult Adverse Childhood Experience Questionnaire |
* Providers who complete ACEs Aware training are eligible for a $29 reimbursement per eligible screening for pediatric and adult patients up to age 64.
Resources
For screening tools, clinical guidance, and provider trainings, visit:
- ACEs Aware: https://acesaware.org
- Proposition 56 ACEs Overview: CenCal Health Prop 56
- 2025 Provider Manual: CenCal Health Provider Manual
For questions, please contact populationhealth@cencalhealth.org or practicetransformation@cencalhealth.org.