DHCS specifies BHSA service claiming codes for January 2027
Oct 11, 2026 edition · GC-2026-0270 · Published 2026-10-11 · Version 3 · Final
DHCS sets January service-date identifiers for BHSA-related Medi-Cal claims. Optional EBP bundles, mandatory monthly wraparound claiming, and tracking modifiers have different billing and authorization consequences.
What happened
From January 1, 2027 service dates, county behavioral health plans must identify covered EBP, other Full Service Partnership, and early-intervention services using BHIN 26-031. Plans may elect monthly bundles for ACT, FACT, coordinated specialty care, and IPS supported employment using H0040, H0039, H2040, and H2023 respectively. Their corresponding unbundled pathways use appropriate service codes with WJ, WK, WC, and WD. Bundled ACT and FACT require prior authorization; their unbundled pathways do not. The notice also preserves a specified additional unbundled-claim pathway for opted-in ACT/FACT members receiving at least 12 services monthly.
Every BHP must claim High Fidelity Wraparound monthly with H2022, with no unbundled alternative. Other FSP and early-intervention identifiers apply to all BHPs: WI for intensive care management, WA for assertive field-based SUD initiation, WF for other FSP, HX for early-intervention EBPs/CDEPs, and WB for other early intervention, paired with the appropriate service families. These modifiers support tracking and reporting without changing adjudication. Housing interventions are outside Short Doyle SMHS/DMC/DMC-ODS claiming. The notice retains a BHIN 26-XXX placeholder and anticipates further HFW coverage guidance, so the existing monthly requirement should be implemented without treating that future guidance as already issued.
Scope and timing
- Authority status
- Final
- Applicability
- Directly applicable
- Audience
- Health systems, Provider networks
- Jurisdiction
- California
- Affected functions
- Revenue Cycle, Coding, Clinical Operations, IT, Managed Care
- Responsible owner
- Revenue Cycle
- Recorded date
- 2027-01-01
- Date type
- implementation
Why it matters
Tracking modifiers support performance measurement and do not affect adjudication. HFW requires monthly bundled claiming; forthcoming HFW guidance remains a dependency. Housing interventions are not claimed as SMHS, DMC or DMC-ODS through Short Doyle.
Recommended action
Map bundled and unbundled services separately and test the notice's exact table with county partners. Playbook dates are recommended internal targets, except any explicitly identified agency date.
Implementation playbook
- Map EBP, other FSP and EI services to the specified claiming table with county partners. Coding · Due 2026-10-25
- Test bundled versus unbundled claim examples and tracking modifiers in the claims system. IT · Due 2026-11-15
- Confirm HFW guidance dependencies and keep housing costs outside Short Doyle clinical claims. Revenue Cycle · Due 2026-12-15
Sources
- BHIN 26-031Official · DHCS · 2026-10-05 · Source review 2026-10-11
Complete edition and supplemental material
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