What types of policy changes does Medi-Cal issue?

Medi-Cal regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Medi-Cal update its policies?

Medi-Cal typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Medi-Cal policy changes are tracked here?

This page currently tracks 50 documented Medi-Cal policy changes. New items are added as they are identified.

What should I do when Medi-Cal changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

PAYER POLICY CHANGES

Medi-Cal Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Medi-Cal across CA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Medi-Cal notice. Use the related links below to narrow results by specialty or state, or create a free alert to get new Medi-Cal updates by email (daily or weekly, your choice, on every plan).

Medi-Cal · Effective Dec 31, 2026High impact
New Medi-Cal Providers Web Page: Medi-Cal Managed Care to Fee-for-Service Transition
Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to fee-for-service coverage effective December 31, 2026. Providers currently enrolled only in Medi-Cal managed care must enroll in fee-for-service billing and update their systems to handle Treatment Authorization Requests (TARs) and fee-for-service billing requirements, or they will lose the ability to serve these members.
Medi-Cal · Effective Jan 1, 2027High impact
FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027
Effective January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status move from Medi-Cal managed care plans to Medi-Cal fee-for-service, so FQHC and RHC claims for these members must go directly to the Medi-Cal fiscal intermediary rather than to the former plan. Effective for services on or after January 1, 2027, claims sent to the former plan or to the FI for an MCP differential (wrap) rate will be denied, and from July 1, 2027, emergency and pregnancy-related services for these members are reimbursed only at the PPS rate with the appropriate diagnosis code and emergency indicator.
Medi-Cal · Effective Jan 1, 2027High impact
ICF/DD-CNC Waiver Services Transition to LTC and a Reference Guide is Available
Effective January 1, 2027, ICF/DD-CNC waiver services are transitioning from outpatient billing guidelines to Long Term Care (LTC) billing guidelines. Two specific HCPCS code and modifier combinations (T2033 with modifiers U8 and U9) will no longer be reimbursable, and providers must transition to existing LTC policies and new ICF/DD-CNC billing code sets.
Medi-Cal · Effective Jan 1, 2027High impact
Medi-Cal Fee-for-Service Transition for UIS Members
Beginning January 1, 2027, Medi-Cal members with Unsatisfactory Immigration Status (UIS) will transition from managed care to fee-for-service Medi-Cal. Providers must enroll in Medi-Cal fee-for-service billing, update PAVE enrollment, and comply with fee-for-service billing requirements including Treatment Authorization Requests (TARs) to continue serving these members after December 31, 2026.
Medi-Cal · Effective Jan 1, 2027High impact
AMA to Update Global Obstetric CPT Code Structure
Effective January 1, 2027, the AMA is replacing the current global obstetric CPT code structure with a disaggregated framework that separately bills antepartum care, labor management, delivery care, and postpartum services. Medi-Cal will align with these changes subject to CMS approval, requiring billing teams to transition from bundled maternity codes to individual service-specific codes.
Medi-Cal · Effective Feb 1, 2027High impact
Ordering, Referring and Prescribing: NPI Requirements for DME and Clinical Laboratory Providers
Effective February 1, 2027, DME and Clinical Laboratory providers billing Medi-Cal must include a valid 10-digit Individual (Type 1) Ordering provider NPI on applicable claims. The Ordering NPI must be actively enrolled as a participating Medi-Cal provider by May 1, 2027. Claims will be denied if the Ordering provider NPI is missing, invalid, inactive, not on NPPES, or is a group NPI. Specific HCPCS codes with replacement modifiers are exempt from this requirement.
Medi-Cal · Effective Feb 1, 2027High impact
Ordering, Referring and Prescribing: NPI Requirements for LTC Providers
Effective February 1, 2027, Long Term Care (LTC) providers billing Medi-Cal must include both valid Attending and Referring provider NPIs (Type 1 Individual) on all claim forms, including UB-04. An Attending NPI is mandatory on all claims; both NPIs are required on initial, discharge, and transfer claims. Claims will be denied if NPIs are invalid, missing, inactive, or not Type 1 Individual NPIs on the NPPES file for the date of service billed.
Medi-Cal · Effective Jan 1, 2027Medium impact
Medi-Cal Fee-for-Service Provider Toolkit for UIS Transition is Available
Medi-Cal published a provider toolkit to help providers prepare for the federal requirements starting January 1, 2027, under which Medi-Cal members with Unsatisfactory Immigration Status (UIS) who receive care through Medi-Cal fee-for-service will transition out of managed care. The toolkit covers accepting new patients, enrolling in Medi-Cal fee-for-service, verifying eligibility, TAR continuity, transportation services, and services available in both managed care and fee-for-service, and is posted on the Ordering, Referring and Prescribing and Medi-Cal Managed Care to Fee-for-Service Transition web pages.
Medi-Cal · Effective Jan 1, 2027Medium impact
Hospital Presumptive Eligibility: New Requirements Coming January 1, 2027
Starting January 1, 2027, the Hospital Presumptive Eligibility (HPE) program will implement new 'Work and Community Engagement Requirements' for certain adults. Applicants must have a monthly income of at least $580 OR work/volunteer/attend school/job training for 80 hours in the prior month to qualify, unless they meet an exclusion or exception. This affects eligibility determinations and will require billing teams to verify applicant eligibility status.
Medi-Cal · Effective Jan 1, 2027Medium impact
Justice-Involved (JI) Reentry Initiative: New Aid Codes for Members with UIS Coming Soon
Effective January 1, 2027, Medi-Cal will implement new aid codes for members with Unsatisfactory Immigration Status (UIS) who are part of the Justice-Involved (JI) Reentry Initiative. These members will transition from managed care to fee-for-service coverage, remain eligible for full-scope Medi-Cal benefits, but will lose access to Enhanced Care Management and Community Support services. Billing teams must prepare to identify and process claims for these new aid codes separately from managed care claims.
Medi-Cal · Effective Jan 1, 2027Medium impact
SNF WSP Opt-In Period for Calendar Year 2027
California's Skilled Nursing Facility Workforce Standards Program has opened its opt-in period for 2027, allowing SNFs to receive enhanced Medi-Cal per diem rates. Facilities must opt in by August 3, 2026, as previous years' participation does not carry over to 2027.
Medi-Cal · Effective Nov 1, 2026High impact
Coming Soon: Frequency, Mileage and Documentation Updates for NEMT and NMT
Effective November 1, 2026, Medi-Cal will update NEMT and NMT policies, including: NEMT TAR authorization periods capped at 6 months (or 12 months for chronic conditions) requiring new written prescriptions with ICD-10-CM diagnosis codes; NMT frequency limits for code A0120 (two one-way trips per day or five round trips per week) and mileage limits for code A0390 (50 miles maximum per trip); and enhanced documentation requirements for NMT claims. Billing teams must implement these limits, update prior authorization workflows, and ensure compliant claim submissions starting November 1, 2026.
Medi-Cal · Effective Nov 1, 2026High impact
Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
Effective November 1, 2026, Medi-Cal encourages obstetrical providers to submit claims for prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change anticipates the AMA's January 1, 2027 replacement of the global obstetric CPT code structure, allowing separate identification of antepartum, labor, delivery, and postpartum services. Claims must include appropriate gestational age ICD-10 codes (Z3A.00-49 for prenatal) or postpartum codes (O86-O92, Z39.0-2, F53.0-1).
Medi-Cal · Effective Nov 1, 2026High impact
Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH
Effective November 1, 2026, Medi-Cal encourages obstetrical providers to bill prenatal and postpartum care using E&M codes (99204, 99205, 99213, 99214, 99215) with modifier TH instead of global obstetric codes. This change aligns with upcoming AMA coding framework changes (effective January 1, 2027) that separately identify antepartum, labor, delivery, and postpartum services. Prenatal claims must include gestational age codes (Z3A.00-Z3A.49); postpartum claims must include relevant postpartum diagnosis codes (O86-O92, Z39.0-Z39.2, or F53.0-F53.1).
Medi-Cal · Effective Oct 15, 2026High impact
ICD-10-CM Requirements for FQHC, RHC, IHS-MOA and Tribal FQHC Providers
Effective October 15, 2026, Medi-Cal requires at least one clinically appropriate ICD-10-CM code on all UB-04 and 837I claims submitted by FQHCs, RHCs, IHS-MOA, and Tribal FQHCs. Billing teams must ensure diagnosis codes are present on all outpatient claims for these provider types to avoid claim denials.
Medi-Cal · Effective Oct 15, 2026High impact
Update: ICD-10-CM Requirements for FQHCs, RHCs, IHS-MOA and Tribal FQHCs
Effective October 15, 2026, Medi-Cal requires FQHCs, RHCs, IHS-MOA clinics, and Tribal FQHCs to include one or more valid, clinically appropriate ICD-10-CM diagnosis codes on all claim submissions (UB-04 or 837I forms). Claims submitted without valid ICD-10-CM diagnosis codes will be denied.
Medi-Cal · Effective Oct 13, 2026High impact
New Federal Reimbursement Limitations on Gender Affirming Care for Youth, Effective October 13, 2026
Effective October 13, 2026, California will prohibit Medi-Cal and CHIP federal reimbursement for gender-affirming surgical interventions and medications (puberty blockers, hormone therapy) for members under 18/19 years old. These services will shift to state-only HCAI grant funding instead of traditional Medi-Cal claims. Existing hormone therapy patients have a six-month transition period (through April 12, 2027) to continue Medi-Cal reimbursement. Billing teams must implement new claim routing workflows and monitor HCAI guidance.
Medi-Cal · Effective Oct 1, 2026High impact
DRG Payment System Update to Mapper Version 44.0 on October 1, 2026
Effective October 1, 2026, Medi-Cal updated the DRG Mapper to version 44.0 to incorporate new ICD-10-CM and ICD-10-PCS codes released by CMS. Providers submitting claims with new codes for admission dates on or after October 1, 2026 may experience denials if the Medi-Cal system update was incomplete at submission time. Medi-Cal will reprocess affected claims through an Erroneous Payment Correction process, and providers may resubmit previous claims using this updated guidance.
Medi-Cal · Effective Oct 1, 2026High impact
Dialysis Services Coverage Update for Members with Restricted Scope Aid Codes
Effective October 1, 2026, maintenance dialysis services and transportation to/from dialysis clinics are now state-only covered benefits for Medi-Cal members with unsatisfactory immigration status (UIS) enrolled in restricted scope aid codes, regardless of age. Providers may hold claims or allow DHCS to automatically reprocess affected claims through an Erroneous Payment Correction (EPC); no manual action is required unless directed otherwise.
Medi-Cal · Effective Oct 1, 2026High impact
2026 HCPCS Quarter 4 Update
Medi-Cal has released the 2026 Quarter 4 HCPCS code updates, which include code additions, changes, and deletions effective October 1, 2026. The billing team must obtain and implement the detailed code changes from the HCPCS Policy Updates PDF, with complete policy guidance to follow in a future Medi-Cal Update.
Medi-Cal · Effective Oct 1, 2026High impact
Public Fee-For-Service Provider Directory: Action Required
Providers must complete quarterly validation of their Public Fee-For-Service Provider Directory information through the Provider Portal, beginning October 1, 2026. All survey questions must be answered within 45 days each quarter to maintain access to the Provider Portal Transaction Center. Failure to comply will result in complete loss of portal access for all users in the organization.
Medi-Cal · Effective Oct 1, 2026High impact
Upcoming Medi-Cal Learning Portal Transition Will Impact PE Determination Access
Medi-Cal is transitioning the Learning Portal in October 2026, which will enforce individual PE (Presumptive Eligibility) certification alignment. Staff performing PE determinations must have their own MLP account with matching credentials and complete required PE training individually—organizations can no longer rely on shared training records. Failure to comply before October 2026 will result in loss of PE determination access.
Medi-Cal · Effective Sep 29, 2026High impact
One-Time Timeliness Waiver for LMFT and Psychological Associate Services Delivered by a RHC or FQHC
DHCS has implemented a one-time 60-day timeliness waiver (September 29, 2026 to November 29, 2026) allowing RHCs and FQHCs to submit and receive reimbursement for Psychological Associate services (under licensed clinical psychologist supervision) and LMFT services with dates of service on or after January 1, 2025, that were previously held or unpaid. Claims must meet specific billing code, practitioner identification, and documentation requirements to qualify.
Medi-Cal · Effective Sep 1, 2026High impact
Medi-Cal Hospice Program Attestation Now Available in the Provider Portal
Medi-Cal hospice providers must now submit a Medi-Cal Hospice Attestation through the Provider Portal within 5 calendar days of members electing hospice services. The signed DHCS 8052 form must be retained in the member's medical record but is not submitted to DHCS; attestation in the portal serves as the official notice to the Department of Health Care Services.
Medi-Cal · Effective Sep 1, 2026High impact
Reminder: Medi-Cal Hospice Program Attestation Form Transition to Provider Portal
Effective September 1, 2026, Medi-Cal hospice providers must transition from submitting the Hospice Program Attestation Form via web to using the Medi-Cal Provider Portal. Attestation forms must be submitted within 5 calendar days of member hospice election, and the signed DHCS 8052 form must be retained in the medical record. A mandatory training webinar is scheduled for August 26, 2026.
Medi-Cal · Effective Sep 1, 2026High impact
Coming Soon: Medi-Cal Hospice Program Attestation Form Moving to the Medi-Cal Provider Portal
Effective September 1, 2026, Medi-Cal hospice providers must submit the Hospice Program Attestation form through the Medi-Cal Provider Portal instead of the current web-based form. The old form will no longer be accessible. Providers without Portal access will be unable to submit attestations and may experience delays.
Medi-Cal · Effective Aug 1, 2026High impact
Coverage and Billing Policy Updates for DME and Wheelchair Repairs, Maintenance and Replacement Parts, Among Other Policy Clarifications
Effective August 1, 2026, Medi-Cal is increasing TAR (Treatment Authorization Request) thresholds for DME purchases from $100 to $500 and for wheelchair repairs/maintenance from $250 to $2,500 per calendar month. Additionally, HCPCS code K0462 (temporary wheelchair replacement) is being converted from a non-standard to a standard benefit with a 2x/year frequency limit and RR modifier requirement.
Medi-Cal · Effective Jul 21, 2026High impact
Guidance for Medicare/Medi-Cal Crossover Claim Submission on the Paper CMS-1500
California Medi-Cal has issued updated guidance for submitting Medicare/Medi-Cal crossover claims on paper CMS-1500 forms. Providers must now submit crossover claims directly to the California MMIS Fiscal Intermediary at a specific Sacramento address, with strict formatting requirements for key CMS-1500 fields (Boxes 1, 1A, 9A, and 11C) and must attach a corresponding Medicare Remittance Notice with each submission. Claims not meeting these requirements will be returned.
Medi-Cal · Effective Jul 16, 2026High impact
Justice-Involved (JI) Reentry Initiative: Billing Requirements for Care Management Bundle 4, Procedure Code T2024
Effective immediately, procedure code T2024 (Reentry Care Plan) for Justice-Involved reentry initiatives must be billed using "from-through" date format, with the "from" date as the day prior to service completion and "through" date as the completion date. Claims not following this format will be denied with RAD code 0394. Additionally, T2024 may only be billed once per member per episode of incarceration.
Medi-Cal · Effective Jul 10, 2026High impact
Justice-Involved (JI) Reentry Initiative: Claim Submission and Timeliness Reminder
Medi-Cal has implemented a timeliness penalty structure for Justice-Involved (JI) Reentry providers. Claims must be submitted within 6 months of service for full reimbursement; late claims face graduated reductions (75% for months 7-9, 50% for months 10-12) and are denied entirely after 12 months. Approved delay reason codes may provide exceptions.
Medi-Cal · Effective Jul 6, 2026High impact
Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology
Medi-Cal clarifies that Justice-Involved (JI) pre-release services use standard fee-for-service reimbursement methodology with no separate JI billing structure. Providers must apply unit values, conversion factors, split billing rules for professional/technical components, timely filing penalties, and specific JI adjustments (Modifier QJ 10% bump offset by 1% W&I Code 14105.191 reduction) to calculate accurate reimbursement.
Medi-Cal · Effective Jul 4, 2026High impact
Important Update: One-Year Restriction on Federal Payments to “Prohibited Entities” Under H.R. 1 Section 71113 Ends Effective July 4, 2026
Effective July 4, 2026, the one-year federal payment restriction on 'Prohibited Entities' under H.R. 1 Section 71113 expires, allowing these entities to resume submitting Medi-Cal and Family PACT claims for services rendered on or after that date. For the transition period (July 4, 2025–July 3, 2026), DHCS will not penalize providers for non-submission of claims or lack of associated documentation.
Medi-Cal · Effective Jul 1, 2026High impact
Reimbursement Rates for Select Physician-Administered Drug Codes
Medi-Cal has established new reimbursement rates for select physician-administered drug codes effective July 1, 2026. Providers must update billing systems to reflect these rates and may submit claims for reprocessing or correction of previously erroneously paid claims under this new rate structure.
Medi-Cal · Effective Jul 1, 2026High impact
Diagnosis Related Group (DRG) Pricing Resources SFY 2026/27
California DHCS has updated DRG Grouper Settings for State Fiscal Year 2026/27 (effective July 1, 2026) to reflect Solventum Grouper software updates. Hospitals must import the new SFY 2026/27 DRG Grouper Import File (CSV format) to ensure grouper settings match DHCS standards. Critical requirement: When using Solventum Core Grouping Software for claims with admit dates on or after July 1, 2026, procedure dates must be entered with relevant procedure codes to ensure accurate DRG assignment and reimbursement.
Medi-Cal · Effective Jul 1, 2026High impact
2026 HCPCS Quarter 3 Update
Medi-Cal released Q3 2026 updates to HCPCS coding system effective July 1, 2026. The policy includes code additions, changes, and deletions affecting multiple service categories. Specific code details are contained in a separate HCPCS Policy Updates PDF that must be reviewed to identify which codes impact your billing workflows.
Medi-Cal · Effective May 20, 2026High impact
Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394
For Medi-Cal's Cell and Gene Therapy Access Model, providers must now use UB-04 claim forms (or 837I electronic) instead of CMS-1500 forms when billing HCPCS codes J3392 (Casgevy) and J3394 (Lyfgenia) for sickle cell disease treatment. Claims submitted on CMS-1500 forms will be denied.
Medi-Cal · Effective Apr 1, 2026High impact
Update for Select ICD-10-CM/PCS Codes for 2026
CMS has added 83 new ICD-10-PCS procedure codes that became effective April 1, 2026. Healthcare practices must use these new codes for all visits and encounters occurring on or after April 1, 2026.
Medi-Cal · Effective Apr 1, 2026High impact
Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026
The DRG Payment System updated to Solventum version 43.1 Hospital-Acquired Condition (HAC) list effective April 1, 2026, incorporating new ICD-10 CM and PCS HAC codes from CMS. Claims submitted with old HAC codes for admissions on or after April 1, 2026 may be denied with specific RAD codes, and providers should include Present On Admission (POA) indicators to prevent claim delays.
Medi-Cal · Identified Oct 21, 2026High impact
Ordering, Referring and Prescribing: FAQs Available
DHCS is enforcing a CMS mandate requiring providers billing Medi-Cal to include the Ordering, Referring, and/or Prescribing National Provider Identifier (NPI) on claims for covered goods and services. DHCS has published FAQs to assist with enrollment and billing instructions for complying with this requirement.
Medi-Cal · Identified Oct 10, 2026High impact
Non-Payment of Inappropriate Claiming for Members Not Enrolled in the ALW Program
DHCS is notifying California facilities that claims for Assisted Living Waiver (ALW) services may be denied if members are not properly enrolled in the ALW program or if claims do not comply with ALW requirements. DHCS is currently reviewing previously paid claims and may deny or reprocess erroneously paid claims. Facilities must verify ALW eligibility before delivering services, comply with all ALW standards and policies, submit claims with correct procedure codes and modifiers, and review internal processes to ensure accurate claiming and documentation.
Medi-Cal · Identified Sep 1, 2026High impact
Reminder: Policy Clarifications for Covered Medi-Cal CHW Services
DHCS has published clarifications on Medi-Cal coverage for Community Health Worker (CHW) services, specifically addressing billing requirements for individual services (CPT 98960, HCPCS G0019/G0022) and group services (CPT 98961/98962), telehealth modality use, and health navigation services. The policy emphasizes that CHWs may now assist members with maintaining Medi-Cal enrollment and enrollment in related assistance programs (CalWORKs, CalFRESH) as part of covered health navigation services.
Medi-Cal · Identified Aug 14, 2026High impact
Reminder: Medi-Cal Providers May Not Charge Members to Complete Forms or Provide Information
Medi-Cal providers are prohibited from charging patients any fees for completing forms or providing information needed to support claims or appeals for public benefit program eligibility. This is a reminder of existing California Health & Safety Code Section 123114 requirements, as DHCS has observed an increase in improper fee-charging practices.
Medi-Cal · Effective Nov 1, 2026Medium impact
UIS Transition TAR Submission Process: Guidance for Medi-Cal Providers
Effective November 1, 2026, Medi-Cal fee-for-service providers must use a new UIS transition TAR submission process via the Medi-Cal Provider Portal's eTAR application for members transitioning from Managed Care Plans with existing MCP authorizations. Providers must select the special handling option 'UIS transition where MCP authorization exists,' include service dates, and are not required to submit supporting medical documents or complete all standard TAR fields.
Medi-Cal · Effective Nov 1, 2026Medium impact
November 2026 Updates to the Medi-Cal List of Contracted Incontinence Creams and Washes
Effective November 1, 2026, the California Department of Health Care Services (DHCS) will update the Medi-Cal List of Contracted Incontinence Creams and Washes based on an annual review. This change applies only to fee-for-service Medi-Cal members; managed care members must follow their individual plan formularies. The specific product list changes will be released in a future Medi-Cal Update.
Medi-Cal · Effective Oct 13, 2026Medium impact
New Pharmacy Pathway for Gender Affirming Care Medications for Youth
Effective October 13, 2026, federal reimbursement limitations on gender affirming care medications for youth enrolled in Medi-Cal and CHIP are now in effect. California has established a new pharmacy pathway through Pucci's Pharmacy to manage prescriptions for affected youth, requiring prescribers and pharmacies to submit orders directly to this contracted provider using new submission procedures.
Medi-Cal · Effective Oct 1, 2026Medium impact
National Correct Coding Initiative Quarterly Update for October 2026
CMS has released the quarterly National Correct Coding Initiative (NCCI) payment policy updates effective October 1, 2026. These mandatory national edits will be incorporated into the Medi-Cal claims processing system for all claims received on or after that date. The specific coding changes and edits are not detailed in this notice.
Medi-Cal · Effective Sep 1, 2026Medium impact
Hospice Attestation Form Transition into Medi-Cal Provider Portal: September and October 2026 Office Hour Q&A Session
The California Department of Health Care Services (DHCS) is transitioning Medi-Cal Hospice Attestation form submissions from manual submission to the Medi-Cal Provider Portal, effective September 1, 2026. Hospice providers must ensure they are registered and have appropriate access in the Provider Portal before this date to avoid submission delays. DHCS is offering three Q&A sessions (September 3, September 15, and October 6, 2026) to support the transition.
Medi-Cal · Effective Sep 1, 2026Medium impact
Coming Soon: Transition of the Web-Based Medi-Cal Hospice Program Attestation Form to the Medi-Cal Provider Portal
Starting September 1, 2026, Medi-Cal hospice providers must submit their Hospice Program Attestation Forms through the Medi-Cal Provider Portal instead of the current web-based system, which will be permanently shut down. Providers without portal access will be unable to submit required attestation forms.
Medi-Cal · Effective Aug 20, 2026Medium impact
Provider Dispute Resolutions with Managed Care Plans
This policy clarification updates provider dispute resolution eligibility for Medi-Cal Managed Care Plans, specifically clarifying that non-contracted providers with a letter of agreement or single case agreement where service was authorized are eligible to receive reimbursement at the agreed-upon rate for covered services when the member was eligible and enrolled on the date of service. The policy reiterates that all MCPs must have a fast, fair, and cost-effective dispute resolution mechanism available, and providers can dispute unpaid claims (after 30 days), claim denials, or lack of response within 30 days of clean claim submission.
Medi-Cal · Effective Aug 11, 2026Medium impact
Sterilization Consent Form Now Available in Additional Languages
Medi-Cal and Family PACT Program have updated the Consent for Sterilization (DHCS 8649) form to now be available in all threshold languages. Additionally, updated sterilization education booklets are now available. Providers must use only the official DHCS 8649 consent form for all sterilization services billing to Medi-Cal.

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New Medi-Cal Providers Web Page: Medi-Cal Managed Care to Fee-for-Service Transition

FQHC and RHC Policy for UIS Members Transitioning to Fee-for-Service on January 1, 2027

ICF/DD-CNC Waiver Services Transition to LTC and a Reference Guide is Available

Medi-Cal Fee-for-Service Transition for UIS Members

AMA to Update Global Obstetric CPT Code Structure

Ordering, Referring and Prescribing: NPI Requirements for DME and Clinical Laboratory Providers

Ordering, Referring and Prescribing: NPI Requirements for LTC Providers

Medi-Cal Fee-for-Service Provider Toolkit for UIS Transition is Available

Hospital Presumptive Eligibility: New Requirements Coming January 1, 2027

Justice-Involved (JI) Reentry Initiative: New Aid Codes for Members with UIS Coming Soon

SNF WSP Opt-In Period for Calendar Year 2027

Coming Soon: Frequency, Mileage and Documentation Updates for NEMT and NMT

Reminder: Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH

Obstetrical Providers Encouraged to Use E&M Codes with Modifier TH

ICD-10-CM Requirements for FQHC, RHC, IHS-MOA and Tribal FQHC Providers

Update: ICD-10-CM Requirements for FQHCs, RHCs, IHS-MOA and Tribal FQHCs

New Federal Reimbursement Limitations on Gender Affirming Care for Youth, Effective October 13, 2026

DRG Payment System Update to Mapper Version 44.0 on October 1, 2026

Dialysis Services Coverage Update for Members with Restricted Scope Aid Codes

2026 HCPCS Quarter 4 Update

Public Fee-For-Service Provider Directory: Action Required

Upcoming Medi-Cal Learning Portal Transition Will Impact PE Determination Access

One-Time Timeliness Waiver for LMFT and Psychological Associate Services Delivered by a RHC or FQHC

Medi-Cal Hospice Program Attestation Now Available in the Provider Portal

Reminder: Medi-Cal Hospice Program Attestation Form Transition to Provider Portal

Coming Soon: Medi-Cal Hospice Program Attestation Form Moving to the Medi-Cal Provider Portal

Coverage and Billing Policy Updates for DME and Wheelchair Repairs, Maintenance and Replacement Parts, Among Other Policy Clarifications

Guidance for Medicare/Medi-Cal Crossover Claim Submission on the Paper CMS-1500

Justice-Involved (JI) Reentry Initiative: Billing Requirements for Care Management Bundle 4, Procedure Code T2024

Justice-Involved (JI) Reentry Initiative: Claim Submission and Timeliness Reminder

Justice-Involved (JI) Reentry Initiative: Medi-Cal Fee-for-Service Reimbursement Methodology

Important Update: One-Year Restriction on Federal Payments to “Prohibited Entities” Under H.R. 1 Section 71113 Ends Effective July 4, 2026

Reimbursement Rates for Select Physician-Administered Drug Codes

Diagnosis Related Group (DRG) Pricing Resources SFY 2026/27

2026 HCPCS Quarter 3 Update

Cell and Gene Therapy Access Model Update: UB-04 Claim Form is Required for Reimbursement of HCPCS Codes J3392 and J3394

Update for Select ICD-10-CM/PCS Codes for 2026

Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026

Ordering, Referring and Prescribing: FAQs Available

Non-Payment of Inappropriate Claiming for Members Not Enrolled in the ALW Program

Reminder: Policy Clarifications for Covered Medi-Cal CHW Services

Reminder: Medi-Cal Providers May Not Charge Members to Complete Forms or Provide Information

UIS Transition TAR Submission Process: Guidance for Medi-Cal Providers

November 2026 Updates to the Medi-Cal List of Contracted Incontinence Creams and Washes

New Pharmacy Pathway for Gender Affirming Care Medications for Youth

National Correct Coding Initiative Quarterly Update for October 2026

Hospice Attestation Form Transition into Medi-Cal Provider Portal: September and October 2026 Office Hour Q&A Session

Coming Soon: Transition of the Web-Based Medi-Cal Hospice Program Attestation Form to the Medi-Cal Provider Portal

Provider Dispute Resolutions with Managed Care Plans

Sterilization Consent Form Now Available in Additional Languages