MedicaidPrior AuthHigh impact
21-336m Prior Authorization Reminder for Outpatient Therapy Visits
Health Net·CA · Physical Therapy, Occupational Therapy, PM&R (Physical Medicine & Rehab) +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net now requires prior authorization for physical therapy, occupational therapy, and speech therapy after 12 combined visits for specific Medi-Cal counties and physician providers. Visits 1-12 do not require authorization, but providers must obtain prior auth before continuing treatment beyond 12 visits.
Action Required
Immediately: Billing team must update system to track combined therapy visit counts for Health Net Medi-Cal patients in specified counties. Configure alerts at visit 10-11 to prompt providers to request prior authorization before visit 13. Update encounter forms to remind providers of 12-visit limit. Claims for visits 13+ will be denied without prior authorization.