25-460sum Summary Update: Prior Authorization Changes, Effective April 1, 2025 and July 1, 2025
Date: 05/21/25
Learn what codes for medical benefit medications and other services have been added or removed
Refer to the complete update, 25-460, Prior Authorization Changes, effective April 1, 2025, and July 1, 2025 (PDF), that provides specifics on the following:
- Effective April 1, 2025: new CPT and HCPCS codes issued by the American Medical Association and Centers for Medicare & Medicaid Services (CMS) that require prior authorization.
- Effective July 1, 2025: changes to CPT and HCPCS that require prior authorization.
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
If you have questions regarding the information contained in this update, contact the Plan Provider Services Center by email, by telephone or through the Plan provider portal. Behavioral health providers can call 844-966-0298.
Provider Services
Line of business | Phone number |
|---|---|
Medicare (Individual & Employer Group) (Wellcare By Health Net) | |
Medicare Supplement |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.