24-1318sum Summary Update: New Prior Authorization Changes, Effective March 1, 2025

Date: 12/19/24

Learn which drugs have been added, changed or removed for medical benefit medications

Refer to the complete update, 24-1318, New Prior Authorization Changes, Effective March 1, 2025, for the prior authorization changes detailed below.

Key information includes:

• Changes to Outpatient Pharmaceuticals (Submitted under Medical Benefit) that require prior authorization as of March 1, 2025.
• New CPT and HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) that require prior authorization as of
  October 1, 2024.
• A new supplemental form that has been added to the Outpatient Prior Authorization Form to complete when an authorization request involves more than four procedure codes.

Access the form on the Prior Authorization web page in the Medi-Cal Provider Library > Forms and References.

Additional information

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral Health providers can call at 844-966-0298.
 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.