25-326sum Summary Update: Updates to the Prior Authorization Process, and New and Upcoming Requirements Changes
Date: 04/11/25
Stay aligned with available options for submitting prior authorization requests; discover what’s changed or will change for procedures, services and drugs
Refer to the complete update, 25-326, Updates to the Prior Authorization Process, and New and Upcoming Requirements Changes (PDF), for prior authorization updates detailed below.
Use any of three options for submitting prior authorization requests
Physicians and other providers can submit requests for prior authorization via any of the following:
- Fax – Complete the appropriate Inpatient or Outpatient Medi-Cal Prior Authorization Request form, and fax to 800-743-1655. Forms are available at Prior Authorizations.
- Online – Log on to the secure provider portal.
- Phone – Call Provider Services at 800-675-6110. Behavioral health providers may contact
844-966-0298.
Key prior authorization requirement changes include:
- New CPT and HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) that require prior authorization as of January 1, 2025.
- Additions, effective immediately, on April 1 or on June 15, 2025.
- Additional procedures, services (including durable medical equipment and outpatient pharmaceuticals) that require prior authorization as of April 1, 2025, per new CPT and HCPCS codes issued by CMS, will be communicated in a forthcoming provider update.
- Changes, effective immediately.
- Removals, effective June 15, 2025.
How to access prior authorization requirements
Access the Medi-Cal Prior Authorization requirements at Prior Authorizations and select the Medi-Cal Los Angeles County Department of Health Services (LA-DHS) Participating Physician Groups Prior Authorization List.
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by phone at 800-675-6110. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Los Angeles (LA-DHS)