CommercialPrior AuthHigh impact
25-524sum 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 California has implemented changes to prior authorization requirements effective in multiple phases from April 1, 2025 through August 1, 2025. New CPT and HCPCS codes from CMS now require prior authorization, with additional codes being added on July 1 and August 1, and some codes being removed from prior auth requirements on August 1, 2025.
Action Required
Immediately: Access the complete policy document 25-524 via Health Net Provider Library to identify specific codes requiring prior authorization. Update billing system to flag new CPT and HCPCS codes requiring prior auth effective April 1, 2025. Schedule additional updates for July 1 and August 1, 2025 changes. Train staff on updated prior authorization requirements to prevent claim denials. Contact Health Net Provider Services if clarification needed on specific codes.