Medicare AdvantagePrior AuthHigh impact
Provider Bulletin 06-30-2025 Q3 2025 Prior Authorization Look-Up Tool Update IM IE LA OC SAC SD
Molina Healthcare·CA · Psychiatry, Wound Care, Oncology·Prior Authorization
Effective date
Jun 30, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California has updated their Prior Authorization Look-up Tool for Q3 2025, affecting seven specialty areas including Behavioral Health, DME, Genetic Testing, Healthcare Administered Drugs, Hyperbaric/Wound Care, Transplants/Gene Therapy, and Multiple Categories. The PDF version of the PA Code Matrix is permanently discontinued, making the online tool the only source for prior authorization requirements.
Action Required
Immediately: All staff must switch to using Molina's online Prior Authorization Look-up Tool at molinahealthcare.com for all prior auth determinations. Stop using any saved PDF versions of PA Code Matrix. Check the tool before every PA submission as codes are updated quarterly. Billing team must verify PA requirements for Behavioral Health, DME, Genetic Testing, Healthcare Administered Drugs, Hyperbaric/Wound Care, and Transplant/Gene Therapy services using only the online tool.