25-524sum 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, 25-524, Prior Authorization Changes, Effective April 1, 2025, through August 1, 2025 (PDF), for prior authorization updates detailed below.
Key prior authorization requirements 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 Prior Authorization Requirements:
- Go to the Provider Library, select a line of business, then select Prior Authorization Requirements on the left side.
- Go to Prior Authorization and select the Commercial - California or Medi-Cal Fee-for-Service Prior Authorization List.
Additional information
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.
Provider Services
Line of business | Phone number |
|---|---|
Ambetter from Health Net IFP Ambetter PPO | |
Ambetter HMO | |
Health Net Employer Group HMO, POS, & PPO | |
Medi-Cal (including CS and ECM providers) |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.