MedicaidPrior AuthHigh impact
25-840sum 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 for specific CPT and HCPCS codes are being implemented with different effective dates - some immediately, some November 1, 2025, and others July 1, 2025. This affects Medi-Cal providers in Fresno, Kings and Madera counties and requires updates to billing workflows to obtain prior authorization before submitting claims.
Action Required
Immediately: Access the updated Medi-Cal Prior Authorization Requirements through Provider Library > Medi-Cal > Prior Authorization Requirements or the CalViva Health Prior Authorization List to identify which specific codes now require prior authorization. Update billing system to flag affected CPT and HCPCS codes for prior authorization verification before claim submission. Review provider operations manuals for revised procedures. Failure to obtain required prior authorization will result in claim denials.