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26-075 Updates to the Prior Authorization Requirements
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 20, 2026
Summary
Health Net is updating prior authorization requirements effective April 1, 2026, adding PA requirements for multiple procedures including reconstructive surgery, cardiac procedures, neurostimulators, and EEGs while removing PA requirements for pediatric surgeries, wound care, and certain DME items. These changes affect Commercial, Medi-Cal, and Medicare plans with the goal of reducing administrative burden.
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What to do
by Apr 1, 2026 · 5 steps
01Billing team must update prior authorization workflows for Health Net plans.
02Add PA requirements for codes including reconstructive surgery (15734, 15736, 15738), cardiac procedures (37232, 37236-37239, 37246-37249, 92921), neurostimulators (64555, 64561, 64568), EEGs (95700-95726), and hyperbaric oxygen therapy (99183, G0277).
03Remove PA requirements for pediatric surgeries (11105-11107, 26055, 29848, etc.), wound care (13131-13133, 97602-97610), and ophthalmology cataract procedures (66982, 66984).
04Update billing system rules and provider encounter forms.
05Access current PA requirements via Health Net Provider Library.
Codes mentioned
15734157361573825111298483648237799J04851406021235312543125631267254473723237236372373723837239372463724737248372495854560240602526050064555645616456892921957009571295713957149571595716957189572095721957229572395724957259572699183G027799199B4104B4105T4525T4526T4527T4528T4529T4530T4533T4543L565211105111061110726055520005200552204523515416154640647186471964721A4322E0600E0730E0950E0956L2330L8420L8440L8470L8480L84851313113132131331315313160976029760597606976079760897610S0265E0185E0486L1951K0738J1096812566698266984
Original notice
26-075 Updates to the Prior Authorization Requirements
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related policy hubs
Health Net policiesCA policy changesPlastic SurgeryOrthopedicsCardiologyGeneral SurgeryUrologyNeurologyWound CareOphthalmologyENT (Ear, Nose & Throat)EndocrinologyOB-GYNPediatricsCode 15734Code 15736Code 15738Code 25111Code 29848Code 36482Code 37799Code J0485Code 14060Code 21235Code 31254Code 31256Code 31267Code 25447Code 37232Code 37236Code 37237Code 37238Code 37239Code 37246Code 37247Code 37248Code 37249Code 58545Code 60240Code 60252Code 60500Code 64555Code 64561Code 64568Code 92921Code 95700Code 95712Code 95713Code 95714Code 95715Code 95716Code 95718Code 95720Code 95721Code 95722Code 95723Code 95724Code 95725Code 95726Code 99183Code G0277Code 99199Code B4104Code B4105Code T4525Code T4526Code T4527Code T4528Code T4529Code T4530Code T4533Code T4543Code L5652Code 11105Code 11106Code 11107Code 26055Code 52000Code 52005Code 52204Code 52351Code 54161Code 54640Code 64718Code 64719Code 64721Code A4322Code E0600Code E0730Code E0950Code E0956Code L2330Code L8420Code L8440Code L8470Code L8480Code L8485Code 13131Code 13132Code 13133Code 13153Code 13160Code 97602Code 97605Code 97606Code 97607Code 97608Code 97610Code S0265Code E0185Code E0486Code L1951Code K0738Code J1096Code 81256Code 66982Code 66984