MedicaidPrior AuthMedium impact
24-028m 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
New prior authorization requirements established for palliative care services for Medi-Cal members in Imperial County. Billing teams must submit prior authorization requests with specific diagnosis code Z51.5, procedure code S0311, and supporting medical records before providing palliative care services.
Action Required
Immediately: Billing team must implement prior authorization workflow for palliative care requests using diagnosis code Z51.5 and procedure code S0311 (6 units for 6 months). Complete Outpatient California Medi-Cal Prior Authorization form with medical records documenting advanced acute illness. Select contracted provider from approved list and fax to 800-743-1655 (833-769-1141 for transplants). Allow 5 business days for standard requests, 72 hours for urgent requests. Failure to obtain prior authorization will result in claim denials.