← Back to list
25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Act
by Dec 1, 2025
Effective date
Dec 1, 2025
Identified
Jun 20, 2026
Summary
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for many DME items, prosthetics, sleep studies, varicose vein treatments, and therapy services while maintaining PA requirements for non-emergency air transport, hysterectomies, and skin substitutes. These changes aim to reduce administrative burden and streamline approval processes.
Get alerts when payers change rules like this one
We check Health Net and other payers every day and email you when a change matches your specialty and state.
Get Health Net alertsPolicy Monitoring is free. No card required.
What to do
by Dec 1, 2025 · 3 steps
01Billing team must update prior authorization rules in billing system to remove PA requirements for DME accessories, mattresses, nerve stimulators, wheelchairs, prosthetics, sleep studies, varicose vein treatments, and therapy services over 12 visits.
02Continue requiring PA for non-emergency air transport (A0431, A0436), hysterectomies (58571), and all skin substitute codes.
03Update encounter forms and train staff on new PA requirements to prevent unnecessary delays and claim denials.
Codes mentioned
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
Original notice
25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →21-558 Medical Policies - 2nd Quarter 2021HighNo effective date · Prior Authorization21-555 Medical Policies - 2nd Quarter 2021HighNo effective date · Prior Authorization21-556 Medical Policies - 2nd Quarter 2021HighNo effective date · Prior Authorization25-348 Avoid Unnecessary Denials and Claims Processing Delays by Following These Payment PoliciesMediumEffective Jun 27, 2025 · ReimbursementBrowse every Health Net change in the policy list
Related policy hubs
Health Net policiesCA policy changesOB-GYNVascular SurgeryPhysical TherapyOccupational TherapySleep MedicineWound CarePM&R (Physical Medicine & Rehab)Code A0431Code A0436Code E0953Code K0019Code K0044Code K0045Code K0047Code K0051Code K0052Code E0184Code E0720Code E0730Code E0954Code E0956Code E0957Code E0973Code E0990Code E1016Code E1028Code E2209Code E2210Code E2359Code E2361Code E2363Code E2365Code E2367Code E2603Code E2604Code E2606Code E2607Code E2615Code E2616Code E2624Code K0043Code K0077Code K0733Code G0156Code L5926Code L5617Code 95805Code 58571Code 36471Code 37765Code 37766Code C9358Code C9360Code C9363Code Q4111Code Q4115Code Q4117Code Q4118Code Q4125Code Q4134Code Q4135Code Q4136Code Q4139Code Q4145Code Q4162Code Q4165Code Q4166Code Q4167Code Q4168Code Q4170Code Q4171Code Q4174Code Q4176Code Q4177Code Q4179Code Q4180Code Q4181Code Q4182Code Q4205Code Q4206Code Q4208Code Q4209Code Q4211Code Q4212Code Q4214Code Q4216Code Q4217Code Q4218Code Q4219Code Q4220Code Q4221Code Q4222Code Q4226Code Q4227Code Q4229Code Q4230Code Q4232Code Q4233Code Q4234Code Q4235Code Q4237Code Q4238Code Q4239Code Q4240Code Q4241Code Q4242Code Q4244Code Q4245Code Q4246Code Q4247Code Q4248Code Q4251Code Q4252Code Q4253Code 97010Code 97012Code 97024Code 97033Code 97035Code 97150Code 97542Code G0283