MedicaidPrior AuthMedium impact
24-027m 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
Health Net Medi-Cal now requires prior authorization for palliative care services using specific diagnosis code Z51.5 and procedure code S0311. Requests must include medical records confirming advanced acute illness diagnosis and be submitted to contracted providers only.
Action Required
Immediately: Billing team must obtain prior authorization before providing palliative care services. Use diagnosis code Z51.5, procedure code S0311 with 6 units (6 months), select contracted providers from Health Net's approved list, and fax completed Outpatient California Medi-Cal Prior Authorization form with medical records to 800-743-1655. Claims will be denied without proper prior authorization.