25-522sum Summary Update: Prior Authorization Changes, Effective April 1, 2025, through August 1, 2025

Date: 05/28/25

Learn what codes for medical benefit medications and other services have been added or removed

Refer to the complete update, 25-522, Prior Authorization Changes, Effective April 1, 2025, through August 1, 2024 (PDF), for prior authorization updates detailed below.

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 April 1, 2025.
• Additions and changes, effective immediately, on July 1 and on August 1, 2025.
• Removals, effective August 1, 2025.

How to access prior authorization requirements

Use either option below to access the Medi-Cal Prior Authorization Requirements:

• Go to the Provider Library at Provider Library, select Medi-Cal, then select Prior Authorization Requirements on the left side.
• Go to Prior Authorization and select the Fresno, Kings and Madera counties – CalViva Health Prior Authorization List.

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 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.