MedicaidPrior AuthMedium impact
23-1240 Prior Authorization Changes Effective January 1, 2024
Health Net·CA · Oncology, Neurology, Endocrinology +2 more·Prior Authorization
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
New prior authorization requirements effective January 1, 2024 for specific medical benefit drugs (C9155, C9157, J0801, J0802, J0889, J2781, J9051, J9064, J9345) and long-term care nursing facility admissions for pediatric members under 21. This applies to Health Net and CalViva Health Medi-Cal providers in Fresno, Kings and Madera counties.
Action Required
Immediately: Billing team must update system to require prior authorization for HCPCS codes C9155, C9157, J0801, J0802, J0889, J2781, J9051, J9064, and J9345. Providers must obtain prior authorization before administering these medications or claims will be denied. For long-term care nursing facility admissions for pediatric members under 21, contact Long-Term Care Intake Line at 800-453-3033 or fax 855-851-4563 for prior authorization.