MedicaidBilling CodesHigh impact
21-799m Use Proper Billing for Federally Qualified Health Centers to Receive AB97 Exemption
Health Net·CA · Family Medicine, Internal Medicine, General Practice +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Federally Qualified Health Centers (FQHCs) in Fresno, Kings and Madera counties must use specific billing procedures with UB-04 forms and HCPCS code T1015 with modifier SE to be exempt from AB97's 10% payment reduction for Medi-Cal services. All E&M codes must be listed below the T1015 service line, with only T1015 receiving reimbursement.
Action Required
Immediately: FQHCs in affected counties must update billing procedures to use UB-04 forms with type of bill code 711, place HCPCS code T1015 with modifier SE on the first service line, and list all E&M codes below T1015. Update billing software to enforce this hierarchy. Failure to follow this format will result in the 10% AB97 payment reduction.