MedicaidPrior AuthMedium impact
26-076 Updates to the Prior Authorization Requirements
Health Net·CA · Wound Care, General Practice, Family Medicine +1 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
Health Net is updating prior authorization requirements for LA-DHS Medi-Cal providers effective April 1, 2026. Several new services will require prior auth (including hyperbaric oxygen therapy and incontinence supplies), while many existing requirements are being removed (including wound care procedures and genetic counseling).
Action Required
Before April 1, 2026: Billing team must update prior authorization workflows for affected codes. Add PA requirements for hyperbaric oxygen (99183, G0277), unlisted procedures (99199), enteral nutrition (B4104, B4105), Nulojix (J0485), and incontinence supplies (T4525-T4533, T4543). Remove PA requirements for wound care procedures (13131-13160, 97602-97610), genetic counseling (S0265), and specified DME/prosthetic codes. Update billing system rules and encounter forms accordingly.