25-328sum Summary Update: Updates to the Prior Authorization Process and New Requirements, Effective January 1, 2025
Date: 04/11/25
Stay aligned with available options for submitting prior authorization requests; discover what procedures, services and drugs now require prior authorization
Refer to the complete update, 25-328, Updates to the Prior Authorization Process and New Requirements, Effective January 1, 2025 (PDF), for new CPT and HCPCS codes issued by the Centers for Medicare & Medicaid Services (CMS) that require prior authorization as of January 1, 2025.
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 Medicare Authorization form, and fax to 844-501-5713. Forms are available at Prior Authorizations.
- Online – Log on to the secure provider portal.
- Phone – Call Provider Services at 800-929-9224 or 800-641-7761 for Medicare Supplement. Behavioral health providers may contact 844-966-0298.
How to access the Medicare Prior Authorization requirements:
- Go to the Provider Library, select Medicare Advantage, then select Prior Authorization Requirements on the left side.
- Go to Prior Authorizations and select the Medicare - California 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 email, by telephone or through the Health Net provider portal.
Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.