Notification: DRG Payment System Update to Hospital-Acquired Condition V43.1 on April 1, 2026
AI 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.
Action Required
Immediately: Update billing system to use Solventum version 43.1 Hospital-Acquired Condition (HAC) list for all admissions on or after April 1, 2026. Ensure all claims include Present On Admission (POA) indicators. If claims are denied with RAD codes 67, 9124, 9958, or 9962, resubmit immediately. Contact DRG@dhcs.ca.gov for DRG-related questions.
Affected Billing Codes
Plan Types
Medicaid
States
CA
Specialties
all-specialties