RHC and FQHC timeliness waiver opens for eligible LMFT and psychological associate claims
Oct 4, 2026 edition · GC-2026-0213 · Published 2026-10-04 · Version 2 · Effective
DHCS opens a limited September 29–November 29 waiver for qualifying unpaid RHC/FQHC LMFT and supervised psychological-associate claims.
What happened
DHCS’s September 29 notice offers a one-time filing waiver for PPS-eligible RHC/FQHC psychological-associate services under a licensed clinical psychologist’s direction and supervision, for dates on or after January 1,2025. It also covers qualifying held LMFT claims unpaid under another billable service because the change-in-scope request requirement for adding LMFTs was eliminated under SPA 25-0009. The notice states a September 29–November 29 submission window. All coverage, scope, billing and identification requirements remain, so the waiver does not make every old mental-health claim payable.
The notice specifies revenue 0521 with T1015 or T1015 SE, and for the described dual-eligible members outside Medi-Cal managed care, revenue 900 or 529 with G0469 or G0470. Claims need a clinically appropriate diagnosis and informational-line procedure code, plus Box 80 wording identifying either the Psychological Associate or LMFT timeliness waiver. Psychological-associate claims require the supervising psychologist’s NPI and applicable supervision documentation. A medical or mental-health claim already submitted and adjudicated for the same member and day prevents the override. As of October 4, teams should screen for all conditions before using the open window rather than submit duplicates or assume a timely claim is necessarily covered.
Scope and timing
- Authority status
- Effective
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- California
- Affected functions
- Revenue Cycle, Coding, Clinical Operations, Compliance
- Responsible owner
- Revenue Cycle
- Recorded date
- 2026-11-29
- Date type
- compliance
Why it matters
The waiver can address eligible held claims, but accurate practitioner, code and same-day screening determines whether the limited override applies.
Recommended action
Inventory qualifying unpaid encounters, exclude prior same-day adjudicated services, verify supervision and the exact code/remarks instructions, and submit eligible claims by the notice’s November 29 date.
Implementation playbook
- Inventory eligible unpaid January 1, 2025 and later encounters and exclude previously adjudicated same-day applicable claims. Revenue Cycle · Due 2026-10-18
- Confirm supervision, rendering documentation and the specified T1015 or Medicare crossover code combination. Coding · Due 2026-10-18
- Use the exact Psychological Associate or LMFT timeliness-waiver remarks and submit eligible claims by November 29. Clinical Operations · Due 2026-11-29
Sources
- One-Time Timeliness Waiver for LMFT and Psychological Associate Services Delivered by a RHC or FQHCOfficial · DHCS · 2026-09-29 · Source review 2026-10-05
Complete edition and supplemental material
This finding in the complete approved report →Regulatory horizons, CIA trends and implementation trackers remain in the full report.
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