Medicare AdvantagePrior AuthHigh impact
25-460sum Summary Update: Prior Authorization Changes, Effective April 1, 2025 and July 1, 2025
Health Net·CA·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California is implementing new prior authorization requirements for medical benefit medications and services. New CPT and HCPCS codes will require prior authorization starting April 1, 2025, with additional changes to existing codes requiring prior authorization effective July 1, 2025.
Action Required
By March 31, 2025: Billing team must access the Provider Library Medicare Prior Authorization Requirements section to review the complete policy update 25-460 PDF for specific CPT and HCPCS codes requiring prior authorization. Update billing system rules and encounter forms to flag affected codes for prior authorization verification before services are rendered. Failure to obtain required prior authorization will result in claim denials.