Prior Authorization

For some types of care, your doctor or specialist will need to ask your health network or CalOptima for permission before you get care. This is called asking for prior authorization, prior approval, or pre-approval. It means that your health network or CalOptima must make sure that the care is medically necessary or needed.

Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or relieves severe pain.

The following services always need pre-approval, even if you receive them from a provider in your health network or in the CalOptima network:

You never need pre-approval for emergency care, even if it is out of network. This includes having a baby.

If you would like to request a prior authorization, please contact your primary care provider (PCP) or specialist.

Below are a list of procedure codes that require prior authorization by your provider:

April-June 2024 (Physician-Administered Drug Prior Authorization Required List)  List of procedures that require prior authorization.

April-June 2024 (Medi-Cal)  List of procedures that require prior authorization.

April-June 2024 (OneCare)  List of procedures that require prior authorization.

January-March 2024 (Physician-Administered Drug Prior Authorization Required List)  List of procedures that require prior authorization.

January-March 2024 (Medi-Cal)  List of procedures that require prior authorization.

January-March 2024 (OneCare)  List of procedures that require prior authorization.

October-December 2023 (Physician-Administered Drug Prior Authorization Required List)  List of procedures that require prior authorization.

October-December 2023 (Medi-Cal)  List of procedures that require prior authorization.

October-December 2023 (OneCare)  List of procedures that require prior authorization.

July-September 2023 (Physician-Administered Drug Prior Authorization Required List)  List of procedures that require prior authorization.

July-September 2023 (Medi-Cal)  List of procedures that require prior authorization.

July-September 2023 (OneCare)  List of procedures that require prior authorization.

April-June 2023 (Physician-Administered Drug Prior Authorization Required List)  List of procedures that require prior authorization.

April-June 2023 (Medi-Cal)  List of procedures that require prior authorization, effective 03/01/2023-04/30/2023.

February-March 2023 (Medi-Cal)  List of procedures that require prior authorization, effective 02/01/2023-03/31/2023.

January - January 31, 2023 (Medi-Cal)  List of procedures that require prior authorization, effective 01/01/2023-01/31/2023.

October-December 2022  List of procedures that require prior authorization, effective 10/01/2022-12/31/2022.

July-September 2022  List of procedures that require prior authorization, effective 07/01/2022-09/30/2022.

April-June 2022  List of procedures that require prior authorization, effective 04/01/2022-06/30/2022.

January-March 2022  List of procedures that require prior authorization, effective 01/01/2022-03/31/2022.