MedicaidPrior AuthHigh impact
25-525sum Summary Update: Prior Authorization Changes, Effective April 1, 2025, through August 1, 2025
Health Net·CA·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net is implementing multiple prior authorization requirement changes for Medi-Cal LA-DHS providers with new CPT and HCPCS codes requiring prior auth starting April 1, 2025, additional changes on July 1, 2025, and some requirements being removed on August 1, 2025. This affects medical benefit medications and various services for Los Angeles County Department of Health Services participating physician groups.
Action Required
By April 1, 2025: Billing team must download the complete policy document (25-525 PDF) to identify specific new CPT and HCPCS codes requiring prior authorization. Update billing system and encounter forms for these new requirements. By July 1, 2025: Review and implement additional prior authorization changes. By August 1, 2025: Remove prior authorization requirements for specified codes. Access the Medi-Cal Prior Authorization requirements list and contact Health Net Provider Services at 800-675-6110 for questions.