Medicare AdvantagePrior AuthMedium impact
Provider Bulletin 03-31-2025 Q2 2025 Prior Authorization Look-Up Tool Update IM IE LA OC SAC SD
Molina Healthcare·CA · Wound Care, Diagnostic Imaging, General Surgery·Prior Authorization
Effective date
Mar 31, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California updated their Prior Authorization Look-up Tool for Q2 2025 with changes to Experimental/Investigational services, Healthcare Administered Drugs, Hyperbaric and Wound Care, Imaging & Special Tests, and Outpatient Hospital/ASC procedures. The PDF version of the PA Code Matrix is no longer available - providers must use the online Look-up Tool as the single source of truth.
Action Required
Immediately: Stop using the PDF PA Code Matrix and transition to using Molina's online Prior Authorization Look-up Tool exclusively for all prior authorization determinations. Billing team must bookmark the tool at molinahealthcare.com and check it before each PA submission as codes may be added or removed quarterly. Update staff workflows to reference only the online tool for Experimental/Investigational services, Healthcare Administered Drugs, Hyperbaric and Wound Care, Imaging & Special Tests, and OP Hospital/ASC procedures.