MedicaidPrior AuthHigh impact
26-073 Updates to the Prior Authorization Requirements
Health Net·CA · Cardiology, Neurosurgery, Plastic Surgery +8 more·Prior Authorization
Effective date
Apr 1, 2026
We identified it
Jun 20, 2026
Summary
CalViva Health is updating prior authorization requirements effective April 1, 2026, adding PA requirements for 54 new codes including cardiac procedures, neurostimulators, EEGs, and various surgeries, while removing PA requirements for 26 codes including pediatric surgeries, wound care, and certain DME items.
Action Required
Before April 1, 2026: Billing team must update prior authorization requirements in billing software for 54 new codes requiring PA (including cardiac procedures, EEGs, neurostimulators, and various surgeries) and remove PA requirements for 26 codes (including pediatric surgeries and wound care). Update encounter forms and provider checklists to reflect new requirements. Access updated PA requirements through Provider Library > Medi-Cal > Prior Authorization Requirements. Claims submitted without required prior authorization will be denied.