26-874sum Summary Update: Updates to Prior Authorization Requirements
Date: 07/28/26
Review code changes effective July 1 – October 1, 2026
Refer to the complete update, 26-874, Updates to the Prior Authorization Requirements (PDF), for prior authorization (PA) updates detailed below.
Access the complete update in the Provider Library > select Medi-Cal > Updates and Notices > search for 26-874.
What physicians and other providers need to do
- Review the code lists in the complete update for changes affecting your practice.
- Submit PA requests for applicable services starting on the effective date.
- Verify member eligibility and benefits before providing services. Changes to PA requirements do not constitute, imply or confirm benefit coverage, as authorization requirements are independent of coverage determinations.
- Use current PA requirements when submitting requests.
Key PA requirement changes
- Additions, effective July 1, 2026.
- Addition, effective July 28, 2026.
- Additions and removals, effective October 1, 2026.
How to access PA requirements
Use one of these options:
- Visit Prior Authorizations and select Fresno, Kings and Madera counties – CalViva Health Prior Authorization List.
- Visit Provider Library. > Medi-Cal > Prior Authorization Requirements.
This information applies to Physicians and Practitioners, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, and Behavioral Health Providers.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.