MedicaidPrior AuthHigh impact
25-1082 Understanding Medi-Cal Non-Benefit Billing Codes: What Providers Need to Know
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Medi-Cal has clarified that 'non-benefit' billing codes may still be covered if medically necessary and properly authorized. Providers must check prior authorization requirements for these codes and follow specific claims submission and dispute procedures to avoid denials.
Action Required
Immediately: Billing team must update procedures to check prior authorization requirements for all 'non-benefit' codes in the Medi-Cal Treatment Authorization Request (TAR) and Non-Benefit list before rendering services. Obtain PA when required and include authorization numbers on claims submissions. Update staff training on dispute resolution process for denied non-benefit code claims. Review updated provider operations manuals in the Provider Library on the provider portal.