MedicaidPrior AuthHigh impact
23-1449 Prior Authorization Changes Effective March 1, 2024
Health Net·CA · Vascular Surgery, Cardiology, Oncology +2 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net and CalViva Health Medi-Cal are implementing prior authorization requirements for several new medications and vascular procedures effective March 1, 2024, while removing PA requirements for echocardiograms and ophthalmology use of Vegzelma. The changes include new gene therapy treatments and various endovascular revascularization procedures.
Action Required
By March 1, 2024: Billing team must update prior authorization requirements in billing system for new HCPCS codes J9302, J9293, J2502, J9357 and CPT codes 37220-37231 for vascular procedures. Remove PA requirements for echocardiograms and Q5129 when billed by ophthalmologists. Update encounter forms and notify providers. Claims will be denied without proper prior authorization for newly added codes.