26-076 Updates to the Prior Authorization Requirements
Date: 01/26/26
Changes to codes requiring prior authorization, effective April 1, 2026
As part of our ongoing work to improve the prior authorization (PA) process for physicians, practitioners, other providers and members, Health Net is sharing some important updates to Los Angeles County Department of Health Services (LA-DHS) PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.
How to access prior authorization requirements
Access the Medi-Cal LA-DHS Participating Provider Groups PA requirements list at Prior Authorizations.
Additions, effective April 1, 2026
The below services, procedures, equipment or outpatient pharmaceuticals require PA beginning April 1, 2026.
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Category | CPT/HCPCS code |
|---|---|
Hyperbaric oxygen therapy | 99183, G0277 |
Unlisted services and procedures | 99199 |
Enteral nutrition products | B4104, B4105 |
Outpatient pharmaceuticals: Nulojix® | J0485 |
Durable medical equipment (DME): incontinence supplies | T4525, T4526, T4527, T4528, T4529, T4530, T4533, T4543 |
Removals, effective April 1, 2026
The below services, procedures, equipment or outpatient pharmaceuticals no longer require PA beginning April 1, 2026.
Category | CPT/HCPCS code |
|---|---|
DME: adults − items with a total Medi-Cal purchase price greater than $1,500 | E0600 |
Pediatrics: DME for pediatric members | E0730 |
DME: wheelchair accessory | E0950, E0956 |
Prosthetic | L8420, L8440, L8470, L8480, L8485 |
Wound care | 13131, 13132, 13133, 13153, 13160, 97602, 97605, 97606, 97607, 97608, 97610 |
Genetic counseling | S0265 |
Need help? Contact us
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone at 800-675-6110 or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Los Angeles (LA-DHS).