MedicaidPrior AuthMedium impact
24-489 Medical Medication Prior Authorization Changes and NIA Name Change
Health Net·CA · Oncology, Hematology, Rheumatology +7 more·Prior Authorization
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Multiple new HCPCS codes for specialty medications now require prior authorization for Medi-Cal providers, with different effective dates (January 1, 2024 and April 1, 2024). Some existing prior authorization requirements have been removed or modified, and NIA has been renamed to Evolent Specialty Services.
Action Required
Immediately: Update billing system to require prior authorization for all listed HCPCS codes effective January 1, 2024 and April 1, 2024. By August 1, 2024: Add prior authorization requirements for Benlysta (J0490), Trodelvy (J9317), and Casgevy (J3590). Remove prior authorization requirements for discontinued codes J9037, Q0138, J1726, and J3490. Update provider workflows to reference Evolent instead of NIA for imaging prior authorizations.