26-875sum 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, 26-875, Updates to the Prior Authorization Requirements (PDF), for the prior authorization (PA) updates detailed below.

Access the complete update in the Provider Library > select Medi-Cal > Updates and Notices > search for 26-875.

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 prior authorization requirements

Use one of these options:

• Visit Prior Authorizations and select Imperial County – Community Health Plan of Imperial Valley (CHPIV) 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 Imperial County.