25-537 Provider Communications Posted Online and Operations Manual Updates for May 2025
Date: 06/06/25
Access the Provider Library for the latest operational and Plan updates and changes to better service your patients
The tables below outline provider communications posted online and operations manual changes made in May 2025.
- Communications posted online: Includes the posting date, material number and title, type of communication, applicable audience and counties, and a summary of the communication.
- Medi-Cal Provider Operations Manual changes (for physicians, participating physician groups (PPGs), hospitals, and ancillary providers): Includes the effective date of the change, document name, path to section where document is located, URLs, audience and a summary of the change.
- Behavioral Health Provider Operations Manual: No changes were made to this manual for May 2025.
Communications posted online in May 2025
Date, number and title | Type of notice | Audience | Medi-Cal counties | Summary |
|---|---|---|---|---|
5/1/25 25-374m, Biosimilar Medications Are Preferred – 2nd Quarter | News & Announcements | Physicians PPGs
| Fresno Kings Madera | Stay informed about the use of preferred biosimilar medications. This notice includes a list of brand medications and their preferred biosimilars for easy reference. |
5/21/25 25-473m, Medical Policies – April 2025 | Contractual | Physicians PPGs Behavioral Health providers | Fresno Kings Madera | Review changes to medical policies for procedures and services for April 2025. Medical policies, available online at Medical policies, offer guidelines for determining medical necessity for certain procedures, equipment and services. As a reminder, all services must be medically necessary, and member benefits, legal and regulatory mandates take precedence over content of medical policies and must be applied first. |
5/23/25 25-478m (PDF), Learn Which Anesthesia and Facility Fees are PPG Responsibility for Dental Procedures | Contractual | PPGs
| Fresno Kings Madera | Reminder about reimbursing medically necessary services administered in connection with dental services for anesthesia and facility fees. Links are provided to a previous communication with more details and to other resources available through the Department of Health Care Services (DHCS) and in the Provider Library. Includes quick reference charts from DHCS’ All Plan Letter 23-028 on who processes which fees (anesthesia and facility). |
5/23/25 25-514m, Transforming Mental Health Access for California's Children and Youth | News & Announcements | Physicians PPGs Hospitals Ancillary providers ECM providers CS providers Behavioral Health providers | Fresno Kings Madera | No-cost online behavioral health service tools and resources to help you support California’s Children and Youth Behavioral Health Initiative.
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Medi-Cal Provider Operations Manual changes (for physicians, PPGs, hospitals, and ancillary providers) in May 2025
Effective Date | Document name, path (if applicable) and URL | Audience | Summary |
|---|---|---|---|
5/2/25
| Obesity | Physicians PPGs Hospitals Ancillary | Updated to remove reference to the Fit Families for Life Program, which is no longer available. |
5/14/25 |
(under Benefits > Durable Medical Equipment) | Physician PPGs Hospitals
| Updated and added information for ordering blood pressure monitors or cuffs for Medi-Cal members with the preferred durable medical equipment provider, Western Drugs. |
|
(under Contacts) | Physician PPGs Hospitals Ancillary | ||
Blood Pressure Monitor Request Form (PDF) (under Forms & References) | PPGs Hospitals | ||
5/23/25 | Transplant Performance Centers (under Benefits > Transplants)
| Physician PPGs Hospitals
| Updated the Transplant Performance Center List that’s linked to from the transplant information section under Benefits. The list is also available in the Forms and References section in the Provider Library. |
Behavioral Health Provider Operations Manual changes in May 2025
Effective Date | Section | Topic | Summary |
|---|---|---|---|
5/1/25 | Section 13.1 | AB936 Maternal Mental Health Screening Requirement | Updated AB 1936 section to include reference to members enrolled in Medi-Cal plans (previously, Individual & Family Plan (IFP) and Employer Group plans were referenced only). Also added information that, “Additional screenings must be offered if determined to be medically necessary and clinically appropriate.” |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.