Get Help with Authorizations

Before providing treatment or prescribing medication for an HPSM member, you may need to submit a Prior Authorization Request Form to ensure that it is covered. HPSM expects providers to obtain authorization for all services requiring prior authorization before they provide the service. Exceptions are made for urgent and emergency services.

When is authorization required?

Request prior authorization for:

Prior Authorization List

IMPORTANT NOTE: Prior authorization is based on medical necessity and is not a guarantee of coverage or eligibility. If a service is not included on this list, the service does not require prior authorization. However, this does not mean it is a covered benefit.

Only valid codes will be reviewed. Please refer to CMS/MC guidelines to verify validity. Codes are updated regularly and posted below.

It is expected that all services requiring prior authorization must be authorized before providing the service, with the exception of services that are necessary on an emergent or truly urgent basis. Before submitting a request, search HPSM's Prior Authorization List by CPT code or service name to see if you need to get prior authorization:

Download the PAR List:    Prior Authorization Required List

To use spreadsheet functions, download the Excel file: Prior Authorization Required List

List last Updated 4/01/2019

Prior Authorization List Changes

HPSM periodically updates our list of codes requiring prior authorization to reflect current clinical guidelines. You can review these changes or archived lists on the PAR List Changes page.

Nutritional Supplements for Medical Conditions

The Nutritional Supplements for Medical Conditions Formulary contains nutritional products which are covered by Medi-Cal if certain conditions are met. These include infant formulas, oral nutritional supplements, and enteral nutritional supplements. Providers must submit a Prescription Drug Prior Authorization Request and members must meet the criteria as outlined in the Nutritional Supplements for Medical Conditions Policy.

Incontinence Supplies

The incontinence supply formulary contains products eligible for reimbursement when billing for contracted incontinence supply billing codes for Medi-Cal fee-for-service outpatient recipients. Incontinence supply formulary products are updated on a regular basis. Please visit this page for the latest version of the formulary

Incontinence Supply Formulary:    PDF    Excel
Last Updated 03/01/2019