MedicaidPrior AuthHigh impact
25-522sum 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
CalViva Health (Medi-Cal in Fresno, Kings and Madera counties) is implementing new prior authorization requirements for medical benefit medications and services in multiple phases from April 1 through August 1, 2025. New CMS-issued CPT and HCPCS codes will require prior authorization, with additional changes and removals occurring throughout the summer.
Action Required
By April 1, 2025: Billing team must access the updated Medi-Cal Prior Authorization Requirements through the Provider Library or CalViva Health's county-specific list to identify new CPT and HCPCS codes requiring prior authorization. Update billing system and encounter forms to flag these codes for prior auth verification. Monitor for additional changes on July 1 and August 1, 2025. Contact CalViva Health at 888-893-1569 for questions (844-966-0298 for Behavioral Health).