26-074 Updates to the Prior Authorization Requirements

Before April 1, 2026: Billing team must update prior authorization requirements in billing system for Community Health Plan of Imperial Valley (Medi-Cal). ADD prior auth requirements for 52 new codes including cardiac procedures (37232, 37236-37239, 37246-37249, 92921), reconstructive surgery (14060, 21235, 31254, 31256, 31267), neurostimulators (64555, 64561, 64568), EEGs (95700, 95712-95726), and incontinence supplies (T4525-T4530, T4533, T4543). REMOVE prior auth requirements for 35 codes including pediatric surgeries (11105-11107, 26055, 29848), wound care (13131-13160, 97602-97610), and certain DME items. Update encounter forms and staff training. Contact 833-236-4141 for questions. Claims will be denied without proper prior authorization.