MedicaidPrior AuthHigh impact
25-841sum Summary Update: Updates to the Prior Authorization Requirements
Health Net·CA·Prior Authorization
Effective date
Jul 1, 2025
We identified it
Jun 20, 2026
Summary
New prior authorization requirements are being implemented for specific CPT and HCPCS codes, with changes effective immediately, November 1, 2025, and July 1, 2025. This applies to Medi-Cal providers in Imperial County and affects various healthcare services requiring prior authorization approval before billing.
Action Required
Immediately: Access the updated Medi-Cal Prior Authorization Requirements through Provider Library > Medi-Cal > Prior Authorization Requirements or go to Prior Authorizations and select Imperial County – Community Health Plan of Imperial Valley (CHPIV) Prior Authorization List. Review the complete update 25-841 PDF to identify specific CPT and HCPCS codes requiring prior authorization. Update billing system workflows to flag these codes for prior authorization before claim submission. Failure to obtain required prior authorizations will result in claim denials.