RHC and FQHC timeliness waiver opens for eligible LMFT and psychological associate claims
Oct 11, 2026 edition · GC-2026-0213 · Published 2026-10-11 · Version 3 · Effective
A one-time RHC/FQHC waiver permits qualifying late PPS claims for LMFT and supervised psychological-associate services. The November filing window retains exact coding, practitioner-identification, and same-day exclusions.
What happened
The September 29 notice expressly closes the window November 29. It covers services from January 1, 2025 by registered psychological associates supervised by licensed clinical psychologists. Held LMFT claims qualify when unpaid under another billable service because the change-in-scope request requirement was eliminated under SPA 25-0009. Services must still satisfy PPS coverage, billing, and practitioner scope requirements; the waiver does not reopen every unpaid encounter.
Use revenue code 0521 with T1015 or T1015 SE. For dual-eligible members outside Medi-Cal managed care, the notice specifies revenue 900 or 529 with G0469 or G0470. Include a clinically appropriate diagnosis and informational-line procedure. Box 80 remarks must identify “Timeliness Waiver for Psychological Associate” or “Timeliness Waiver for LMFT.” Associate claims require the supervising clinical psychologist’s NPI and applicable supervision/documentation. Duplicates, incorrect codes or practitioner identification, and claims where a medical or mental-health service was previously adjudicated for the same member that day are ineligible.
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
A limited filing window can recover eligible held claims but does not permit duplicate payment or unsupported services.
Recommended action
Review eligible unpaid claims, apply the notice billing codes and exact waiver remarks, supply supervising psychologist NPI where required and submit by the stated 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 2026-10-11
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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