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Reimbursement Rates for Select Physician-Administered Drug Codes
Effective date
Jul 1, 2026
Identified
Sep 18, 2026
Summary
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.
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What to do
Action · 4 steps
01Before July 1, 2026: Billing team must access the Medi-Cal Rates web page and locate the Maximum Allowable Reimbursement Rates for Physician-Administered Drugs section to identify all affected drug codes and their new rates.
02Update billing system fee schedules to reflect new rates for all physician-administered drug codes effective July 1, 2026.
03Identify and flag any claims with dates of service on or after July 1, 2026 that were paid under old rates for potential resubmission.
04Following the CIF Submission and Timeliness Instructions in the Provider Manual, billing team may elect to correct and resubmit previously underpaid claims.
If missed: Failure to update rates may result in incorrect claim adjudication and revenue loss.
Original notice
Reimbursement Rates for Select Physician-Administered Drug Codes
mcweb.apps.prd.cammis.medi-cal.ca.gov · Always check the source before changing claims.