26-876sum 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, 26-876, Updates to the Prior Authorization Requirements (PDF), for full details on the changes outlined below.
Access the complete update in the Provider Library > select a line of business > Updates and Notices > search for 26-876.
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 one of the following:
- Medi-Cal Fee-for-Service Health Net
- Commercial – California, Medicare – California
- Visit Provider Library. > select a line of business > Prior Authorization Requirements.
This information applies to Physicians and Practitioners, 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.