Medicare AdvantagePrior AuthHigh impact
25-844sum Summary Update: Prior Authorization Requirement Changes, Effective July 1, 2025
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California is implementing new prior authorization requirements for additional CPT and HCPCS codes effective July 1, 2025, as mandated by CMS. Billing teams must identify these new codes and update workflows to obtain prior authorization before services are rendered.
Action Required
Before July 1, 2025: Billing team must access the complete policy document 25-844 in Health Net's Provider Library under Medicare Advantage > Prior Authorization Requirements to identify all new CPT and HCPCS codes requiring prior authorization. Update billing system and encounter forms to flag these codes for prior auth. Train staff on new requirements. Claims without required prior authorization will be denied.