CommercialPrior AuthHigh impact
25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·CA · Psychiatry, Physical Therapy, Orthopedics +9 more·Prior Authorization
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for some services while adding requirements for others. Key changes include removing PA requirements for ABA therapy, physical therapy, and genetic testing while maintaining PA requirements for TMS, certain surgeries, and specific pharmaceuticals.
Action Required
By December 1, 2025: Billing team must update prior authorization requirements in billing system for both Commercial and Medi-Cal plans. Remove PA requirements for ABA therapy (97157), physical therapy (97010), oxygen (E0441), and genetic testing (81244, 81331). Ensure PA requirements remain active for TMS (90867, 90868), cardiovascular procedures (37243), and specific pharmaceuticals. Update encounter forms and staff training materials to reflect new PA requirements. Access updated PA lists through Provider Library or Prior Authorizations portal.