MedicaidPrior AuthHigh impact
21-468 Prior Authorization Changes for California Children’s Services
Health Net·CA · Pediatrics, Cardiology, Dermatology +10 more·Prior Authorization
Effective date
Dec 14, 2024
We identified it
Jun 20, 2026
Summary
Effective immediately, office visits for pediatric subspecialists no longer require prior authorization, but in-office procedures for 13 specific subspecialties (including cardiologists, dermatologists, endocrinologists, etc.) now require prior authorization for CCS-eligible children. This applies to fee-for-service Medi-Cal providers in 9 California counties.
Action Required
Immediately: Billing team must update prior authorization workflows to remove authorization requirements for pediatric subspecialist office visits but add prior authorization requirements for in-office procedures performed by cardiologists, dermatologists, endocrinologists, gastroenterologists, geneticists, nephrologists, neurologists, ophthalmologists, orthopedists, otolaryngologists, podiatrists, pulmonologists, and urologists for CCS-eligible children. Update staff training and encounter forms. Submit CCS referrals within 24 hours with all required documentation.