25-842sum Summary Update: Updates to the Prior Authorization Requirements

Date: 08/27/25

Stay informed on the latest changes to codes, medications and other services and procedures effective now and in the coming months

Refer to the complete update, 25-842, Updates to the Prior Authorization Requirements (PDF), for the prior authorization updates detailed below.

Key prior authorization requirement changes include:

• New CPT and HCPCS codes issued by the Centers for Medicare & Medicaid Services that require prior authorization as of July 1, 2025.
• Additions, effective immediately and on November 1, 2025.
• Changes, effective immediately.

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 > Prior Authorization Requirements (on the left side).
• Go to Prior Authorizations and select the Commercial - California or Medi-Cal Fee-for-Service 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.

 

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, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.