MedicaidDocumentationHigh impact
04-14-2026 Upcoming Medi-Cal Rx Pharmacy Claim Requirements ICD-10-CM Diagnosis Codes IE LA SAC SD
Molina Healthcare·CA·Coding
We identified it
Jun 19, 2026
Summary
Beginning fall 2026, all Medi-Cal Rx pharmacy claims must include ICD-10-CM diagnosis codes or they will be denied. Prescribers must provide diagnosis codes on prescriptions, and pharmacies must include them on all claim submissions including refills.
Action Required
Before fall 2026: Prescribers must include ICD-10-CM diagnosis codes on all prescriptions and document them in patient medical records. Pharmacy providers must begin including ICD-10-CM diagnosis codes on all pharmacy claim submissions immediately and follow up with prescribers when codes are missing. Up to five diagnosis codes may be submitted per claim. Claims without diagnosis codes will be denied and must be resubmitted.