MedicaidPrior AuthMedium impact
24-029m Follow Prior Authorization Requirements to Submit Palliative Care Requests
Health Net·CA · Palliative Care, Oncology, Family Medicine +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Medi-Cal now requires prior authorization for all palliative care services using specific codes and contracted providers. Billing teams must submit prior authorization requests with medical records for members with advanced acute illness before providing palliative care services.
Action Required
Immediately: Billing team must obtain prior authorization before billing palliative care services for Medi-Cal members. Use diagnosis code Z51.5 and procedure code S0311 with 6 units (6 months) on prior authorization requests. Select contracted providers from the Palliative Care Contracted Providers list in Provider Library. Submit completed Outpatient California Medi-Cal Prior Authorization form with medical records to fax 800-743-1655. Standard requests take 5 business days, urgent requests 72 hours. Claims will be denied without proper prior authorization.