MedicaidPrior AuthMedium impact
26-631 Updates to Prior Authorization Requirements
Health Net·CA · Urology, Oncology, Hematology +3 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
LA-DHS Medi-Cal updated prior authorization requirements with immediate changes for incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and new PA requirements effective April 1, 2026 for multiple services including genetic testing, gene therapy drugs, orthotics, prosthetics, and neuro stimulators.
Action Required
Immediately: Update billing system to only require PA for incontinence supplies (T4521-T4533, T4543) when exceeding 186 units/month or $165/month limit. By March 31, 2026: Program billing system to require prior authorization for all listed genetic testing codes (0614U-0630U), gene therapy drugs (C9309, J3404, J9183, J9277, J9601), immune globulin (J1553), denosumab agents (Q5161-Q5162), custom orthotics (A8005-A8006), prosthetics (L5992), and neuro/spinal cord stimulators (C8007, C8008, C8011, C8012). Note: J9003 Camcevi does NOT require PA for urology/hematology. Claims submitted without required PA will be denied.