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Update: ICD-10-CM Requirements for FQHCs, RHCs, IHS-MOA and Tribal FQHCs
Act
by Oct 15, 2026
Effective date
Oct 15, 2026
Identified
Aug 15, 2026
Summary
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.
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What to do
by Oct 15, 2026 · 6 steps
01Billing team must ensure all FQHC, RHC, IHS-MOA, and Tribal FQHC claims include at least one valid, clinically appropriate ICD-10-CM diagnosis code in applicable fields on UB-04 (paper) or 837I (electronic) claim forms.
02Update billing software validation rules to reject claims missing diagnosis codes before submission.
03Train billing staff and providers on ICD-10-CM requirements using the UB-04 Completion: Outpatient Services section of the Medi-Cal provider manual.
04Failure to include valid diagnosis codes will result in claim denials.
05Verify your organization type qualifies under this requirement (FQHC, RHC, IHS-MOA, or Tribal FQHC).
06Monitor for future Medi-Cal Updates with additional implementation details.
Original notice
Update: ICD-10-CM Requirements for FQHCs, RHCs, IHS-MOA and Tribal FQHCs
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.