CommercialPrior AuthHigh impact
26-630 Updates to Prior Authorization Requirements
Health Net·CA · Diagnostic Imaging, Neurology, Orthopedics +3 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Health Net has updated prior authorization requirements with immediate changes to Medi-Cal incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and new PA requirements for multiple services including advanced imaging, genetic testing, neuro stimulators, medications, and orthotics effective April 1, 2026.
Action Required
Immediately: Update billing system to remove prior auth requirement for Medi-Cal incontinence supplies (codes T4521-T4543) unless exceeding 186 units/month or $165 limit. By April 1, 2026: Configure billing software to require prior authorization for all listed codes including advanced imaging G0680, genetic testing codes 0616U-0630U, neuro stimulators C8007-C8012, orthotics A8005-A8006 and L2221, multiple outpatient pharmaceuticals, and skin substitutes. Update encounter forms and train staff on new PA requirements. Claims will be denied without proper authorization.