Prior authorization requirement changes

Effective October 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem for Medi-Cal Managed Care members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

To request PA, you may use one of the following methods:

• Web: Once logged in to Availity Essentials at Availity.com.
• Fax: 800-754-4708
• Phone:
  • Medi-Cal: 888-831-2246
  • MRMIP: 877-273-4193 

Not all PA requirements are listed here. Detailed PA requirements are available to providers on providers.anthem.com/ca on the Resources tab or for contracted providers by accessing Availity.com. For assistance with PA requirements, providers may also call Provider Services at 800-407-4627 outside of Los Angeles County, and 888-258-7801 within Los Angeles County.