New CMS Code Prior Authorization Requirements for Trillium, Health Net and Wellcare

Date: 05/04/26

Trillium Community Health Plan (Trillium), Health Net Health Plan of Oregon, Inc. (Health Net), Wellcare By Trillium Advantage (Wellcare), and Wellcare By Health Net (Wellcare) require prior authorization (PA) as a condition of payment for many services. View this notice (PDF) for information regarding new CMS code prior authorization requirements that are applicable to all commercial, Medicaid, and Medicare products offered.
 
We are committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

For the complete CPT/HCPCS code listing, please see the Online Prior Authorization Tool on our websites at:

• Wellcare By Trillium Advantage: Medicare Pre-Authorization Check
• Wellcare By Health Net: Medicare Pre-Authorization Check
• Health Net: Commercial Pre-Authorization Check
• Trillium Community Health Plan: Medicaid Pre-Authorization Check

Please view this notice (PDF) for prior authorization requirements.

For more information, visit the Frequently Asked Questions section of Trillium's Prior Authorization webpage. If you have additional questions, please contact Trillium Customer Service at 1-877-600-5472 (TTY: 711).