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26-073 Updates to the Prior Authorization Requirements
Effective date
Apr 1, 2026
Identified
Jun 20, 2026
Summary
CalViva Health is updating prior authorization requirements effective April 1, 2026, adding PA requirements for 54 new codes including cardiac procedures, neurostimulators, EEGs, and various surgeries, while removing PA requirements for 26 codes including pediatric surgeries, wound care, and certain DME items.
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What to do
Action · 4 steps
01Before April 1, 2026: Billing team must update prior authorization requirements in billing software for 54 new codes requiring PA (including cardiac procedures, EEGs, neurostimulators, and various surgeries) and remove PA requirements for 26 codes (including pediatric surgeries and wound care).
02Update encounter forms and provider checklists to reflect new requirements.
03Access updated PA requirements through Provider Library > Medi-Cal > Prior Authorization Requirements.
04Claims submitted without required prior authorization will be denied.
Codes mentioned
1406021235312543125631267254473723237236372373723837239372463724737248372495854560240602526050064555645616456892921957009571295713957149571595716957189572095721957229572395724957259572699183G027799199B4104B4105J0485T4525T4526T4527T4528T4529T4530T4533T45431110511106111072605529848520005200552204523515416154640647186471964721A4322E0600E0730E0950E0956L2330L8420L8440L8470L8480L84851313113132131331315313160976029760597606976079760897610S0265
Original notice
26-073 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 changesWound CarePediatricsNeurologyUrologyOrthopedicsPlastic SurgeryOB-GYNCardiologyGeneral SurgeryNeurosurgeryEndocrinologyCode 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 J0485Code T4525Code T4526Code T4527Code T4528Code T4529Code T4530Code T4533Code T4543Code 11105Code 11106Code 11107Code 26055Code 29848Code 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 S0265