MedicaidPrior AuthHigh impact
24-1317sum Summary Update: New Prior Authorization Changes, Effective March 1, 2025
Health Net·CA·Prior Authorization
Effective date
Mar 1, 2025
We identified it
Jun 20, 2026
Summary
New prior authorization requirements are being implemented for outpatient pharmaceuticals under medical benefit and new CMS CPT/HCPCS codes, effective March 1, 2025. A supplemental form has been added for authorization requests involving more than four procedure codes.
Action Required
By March 1, 2025: Billing team must review the complete policy 24-1317 to identify specific drugs and codes requiring prior authorization. Update billing system to flag affected outpatient pharmaceuticals submitted under medical benefit for prior auth. Download and implement the new supplemental form from the Medi-Cal Provider Library for requests with more than four procedure codes. Train staff on new authorization requirements to prevent claim denials.