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Services Not Requiring Prior Authorization

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Sacramento
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Prior authorization is not required for the following services, and services may be obtained from any qualified in-network or out-of-network provider:

  • Minor Consent Services
  • Therapeutic and elective pregnancy termination
  • Family planning, sexually transmitted infection (STI) diagnosis and treatment, HIV testing and counseling, and sexual assault services

Referral and prior authorization is not required for Comprehensive Prenatal Services Program (CPSP) services. Services may be obtained from any participating CPSP providers.

Other services that do not require prior authorization include:

  • Pregnancy care with in-network obstetrician
  • Preventive services
  • Services for emergency medical conditions
  • Specialist referral (initial referral to participating specialist)
Last Updated: 10/30/2019