Medicare AdvantagePrior AuthHigh impact
21-419 New Medications Added to the Prior Authorization Requirements List
Health Net·CA · Oncology, Hematology, Rheumatology +3 more·Prior Authorization
Effective date
Apr 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net has updated their prior authorization requirements for Part B medications, adding 8 new codes requiring prior auth (effective April 1 and August 1, 2021) and removing 4 codes from prior auth requirements effective August 1, 2021. This affects billing for injectable medications and specialty therapies including cancer treatments, immune therapies, and CAR-T cell therapy.
Action Required
Immediately: Billing team must update system to require prior authorization for new codes C9074, J1427, J1554, J7402, Q2053 (effective April 1, 2021) and J3358, J9035, J9210 (effective August 1, 2021). Remove prior auth requirements for codes J0604, J8499, J9144, J9358 (effective August 1, 2021). Use Health Net's Pre-Auth Needed Tool to verify requirements before billing. Update encounter forms to alert providers of new prior auth requirements for these specialty medications.