MedicaidPrior AuthHigh impact
23-1448 Prior Authorization Changes Effective March 1, 2024
Health Net·CA · Oncology, Hematology, Endocrinology +4 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal now requires prior authorization for several new medical benefit drugs and vascular procedures effective March 1, 2024, while removing PA requirements for Vegzelma when used by ophthalmologists. This applies specifically to Los Angeles County Department of Health Services providers.
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 vascular procedure codes 37220-37231. Remove PA requirement for Q5129 (Vegzelma) when billed by ophthalmologists. Update encounter forms and notify providers that claims will be denied without proper prior authorization for these codes.