MedicaidPrior AuthMedium impact
23-1237 Prior Authorization Changes Effective January 1, 2024
Health Net·CA · Oncology, Neurology, Endocrinology +1 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Health Net requires prior authorization for 8 new medical benefit drugs with specific HCPCS codes effective October 1, 2023, and adds prior authorization requirements for long-term care nursing facility admissions for pediatric Medi-Cal members under 21 effective January 1, 2024.
Action Required
Immediately: Billing team must update systems to require prior authorization for HCPCS codes C9155, C9157, J0801, J0802, J0889, J2781, J9051, J9064, and J9345 for all lines of business. By January 1, 2024: Add prior authorization requirement for long-term care nursing facility admissions for Medi-Cal pediatric members under age 21. Contact Health Net Long-Term Care Intake Line at 855-851-4563 (fax) or 800-453-3033 (phone) for approvals. Claims without prior authorization will be denied.