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Medi-CalMedicaid · Billing Codes · Claims & Billing · CAHigh impact

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

Act
immediately
Effective date
Apr 1, 2026
Identified
May 10, 2026

Summary

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.

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What to do

immediately · 4 steps
01Update billing system to use Solventum version 43.1 Hospital-Acquired Condition (HAC) list for all admissions on or after April 1, 2026.
02Ensure all claims include Present On Admission (POA) indicators.
03If claims are denied with RAD codes 67, 9124, 9958, or 9962, resubmit immediately.
04Contact DRG@dhcs.ca.gov for DRG-related questions.

Codes mentioned

V43.1

Original notice

Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.
View original ↗

Related policy hubs

Medi-Cal policiesCA policy changesCode V43.1

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