MedicaidPrior AuthHigh impact
23-1447 Prior Authorization Changes Effective March 1, 2024
Health Net·CA · Oncology, Hematology, Endocrinology +3 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net Medi-Cal is adding prior authorization requirements for several medications and leg stent procedures effective March 1, 2024, while removing PA requirements for certain echocardiograms and ophthalmology use of Vegzelma. This affects providers in specific California counties (Amador, Calaveras, Inyo, Mono, Imperial, and Tuolumne).
Action Required
By March 1, 2024: Billing team must update system to require prior authorization for injection codes J9302, J9293, J2502, J9357 and all leg stent procedures (CPT 37220-37231). Remove PA requirements for echocardiography services and Vegzelma (Q5129) when billed by ophthalmologists. Update encounter forms and notify providers. Contact Health Net at 800-675-6110 for questions. Claims will be denied without proper prior authorization.