MedicaidPrior AuthMedium impact
21-339m Prior Authorization Reminder for Outpatient Therapy Visits
Health Net·CA · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab)·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net California now requires prior authorization for outpatient physical therapy, occupational therapy, and speech therapy services after 12 combined visits for Medi-Cal patients in Fresno, Kings, and Madera counties. The first 12 visits do not require authorization.
Action Required
Immediately: Billing team must update system to track combined therapy visit counts for Medi-Cal patients in Fresno, Kings, and Madera counties. Ensure prior authorization is obtained before scheduling visits 13 and beyond for physical therapy, occupational therapy, and speech therapy. Update encounter forms to alert providers when approaching the 12-visit threshold. Contact CalViva Health at 888-893-1569 for questions.