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24-027m Follow Prior Authorization Requirements to Submit Palliative Care Requests
Act
immediately
Effective date
Not stated in the notice
Identified
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.
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What to do
immediately · 3 steps
01Billing team must obtain prior authorization before providing palliative care services.
02Use 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.
03Claims will be denied without proper prior authorization.
Codes mentioned
Z51.5S0311
Original notice
24-027m Follow Prior Authorization Requirements to Submit Palliative Care Requests
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
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