Short answer: Of the California payers we could check against their own published documents, none require prior authorization for routine, in-network outpatient therapy. Kaiser is the exception, because it sends patients to outside therapists through its own referral. Authorization shows up for psychological testing, intensive programs, and out-of-network care.
If you’re a California therapist, psychologist, or group practice owner billing Medi-Cal plans or commercial insurance, this page is for you.
Prior authorization, referral, and TAR are three different things
Prior authorization means the payer approves a service before you deliver it. Payers also call it precertification or preauthorization. Aetna, for example, uses “precertification.”
A referral means someone sends the patient to you. That might be a primary care provider or the health plan itself. Some plans treat the referral as the authorization, which is how Kaiser works.
A Treatment Authorization Request (TAR) is Medi-Cal fee-for-service’s name for prior authorization. You’ll only see it when you bill Medi-Cal directly, not through a managed care plan.
One more split matters in Medi-Cal. Managed care plans and fee-for-service cover Non-Specialty Mental Health Services (NSMHS), the therapy benefit for adults with mild-to-moderate distress or impairment. County Mental Health Plans cover Specialty Mental Health Services (SMHS) for people who meet the county access criteria. Who pays decides which authorization rules apply.
California therapy prior authorization table
This table covers routine outpatient psychotherapy: 90832 (30 minutes), 90834 (45 minutes), and 90837 (60 minutes). Those are CPT codes, the procedure codes you put on the claim. Every row cites a primary source from the list at the end of this page.
| Payer | Routine in-network therapy needs prior auth? | What does need authorization |
|---|---|---|
| Medi-Cal fee-for-service | No. A TAR isn’t required unless you exceed an age restriction or frequency limit. Patients can self-refer for psychotherapy codes 90832 through 90853. | Services past a frequency or age limit. Psychological testing carries annual limits, for example 96130 at one per year, any provider. |
| All Medi-Cal managed care plans | The initial mental health assessment can’t require prior authorization or a PCP referral when a network provider performs it. Ongoing therapy follows each plan’s own policy. | Whatever the plan lists. DHCS requires plans to tell network providers every service that needs authorization. |
| CalOptima Health (Orange County) | No. CalOptima describes its behavioral health services as open access. | Psychological testing and Behavioral Health Treatment (BHT), including ABA. Every service from a non-contracted provider. |
| IEHP (Riverside and San Bernardino) | No. Since June 1, 2024, IEHP waives authorization for contracted providers billing its listed routine codes, including 90834, 90837, 90847 and 90853. | Codes not on IEHP’s waiver list. All BHT services. |
| L.A. Care (through Carelon Behavioral Health) | No for outpatient services. You still have to confirm eligibility. | Psychological testing. |
| Anthem Blue Cross, Medi-Cal | No for network providers. | Psychological testing. Outpatient care from out-of-network providers. |
| Health Net, Medi-Cal | Initial outpatient mental health assessment: no. Ongoing therapy: | Health Net BH auth |
| Molina Healthcare of California | Molina CA Medi-Cal routine outpatient therapy auth | Psychological and neuropsychological testing. Outpatient services from non-contracted providers. |
| Kaiser Permanente | Referral model. In Southern California, Kaiser screens the patient and books them into your schedule, and that booking notice serves as the referral authorization. | Every new patient comes to you through Kaiser. Don’t start care on a Kaiser member without that referral. |
| Blue Shield of California | Office visits: no, in at least one 2026 PPO plan document. | Outpatient mental health services other than office visits, in that PPO document. Since January 1, 2026, requests go to Blue Shield directly, not Magellan. |
| Optum (UnitedHealthcare behavioral health) | No. Optum states that most plans it administers don’t require it for routine outpatient care. | Non-routine services such as psychological testing and intensive outpatient programs (IOP), plus higher levels of care. |
| Cigna (Evernorth Behavioral Health) | No. Cigna says routine outpatient mental health care requires no prior authorization. | A short list of higher-level services. Cigna also removed authorization for IOP enrollment. Confirm on the member’s plan. |
| Aetna | No. Routine outpatient therapy isn’t on Aetna’s behavioral health precertification list. | ABA, inpatient admissions, partial hospitalization (PHP), residential treatment, and TMS. Aetna has removed psychological testing and IOP from the list. |
| County Mental Health Plans (SMHS) | County plans may not require prior authorization for mental health services, including the initial assessment. | Services outside that protected list, under each county’s utilization management program. |
Not in the table yet: Humana, Oscar, Hoag, and Health Net and Anthem commercial plans. We only list a payer once we can point to its own document. Until then, call the number on the member’s card.
Where authorization actually catches therapists
The table says “no” in most rows, so why do therapy claims still deny for missing authorization? The denials trace back to five situations.
1. You’re out of network or not contracted
The “no authorization” rules above apply to contracted providers. CalOptima requires prior authorization for every service from a non-contracted provider. Aetna publishes a separate precertification request form for outpatient behavioral health from non-participating providers, and Molina lists non-contracted outpatient services on its behavioral health authorization form.
Medi-Cal plans can also require adults to get non-specialty mental health care inside their network. Check your credentialing status with the specific plan before the first session, not after the first denial.
2. You’re doing psychological testing
Psychological testing appears on authorization lists across commercial and Medi-Cal plans. CalOptima, L.A. Care, Optum, and Molina all list it. Aetna is the exception after removing it from its list.
Medi-Cal fee-for-service adds frequency limits on top. The limit for 96130 is one per year, any provider. If another psychologist already billed it this year, your claim can deny even with perfect documentation.
3. You’re stepping up the level of care
Intensive outpatient, partial hospitalization, residential treatment, TMS (transcranial magnetic stimulation), ECT (electroconvulsive therapy), and ABA sit on authorization lists across payers. The details differ. Cigna and Aetna dropped IOP from their lists, while Optum still treats IOP as non-routine.
4. The patient has Kaiser
Kaiser doesn’t work like a PPO. The patient comes to you because Kaiser placed them with you, and that placement is your authorization. A Kaiser member who finds you on their own and books directly is the classic setup for an unpaid claim.
5. You bill Medi-Cal fee-for-service past a limit
Medi-Cal fee-for-service limits individual therapy to one and a half hours per day by the same provider. For adults with persistent symptoms but no diagnosed mental health disorder, it pays up to six psychotherapy sessions per provider, per year. A TAR comes into play once you go past a limit like these.
How long a payer has to decide
For health plans regulated by the California Department of Managed Health Care (DMHC), Health and Safety Code section 1367.01 caps routine decisions at five business days. When the patient faces an imminent and serious threat to their health, the cap is 72 hours.
The five-day clock starts when the plan has the information it reasonably requested, not when you first hit submit. An incomplete packet buys you a request for more records and a restarted wait. Send the diagnosis, treatment plan, and clinical justification the first time.
Federal rules also changed in 2026. Under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), Medicaid managed care plans, Medicare Advantage plans, and Medicaid fee-for-service programs must decide urgent requests within 72 hours and standard requests within seven calendar days. They also have to give a specific reason for every denial. Qualified Health Plans on the federal exchange are excluded from those timeframes.
Which rule applies depends on the plan type, and not every plan falls under either one. Confirm with the payer, and with compliance counsel if a delay is affecting care.
What a missing authorization looks like on your remittance
Payers explain denials with Claim Adjustment Reason Codes (CARCs), standard codes printed on your remittance advice. Two cover authorization problems.
CARC 197 means precertification, authorization, notification, or pre-treatment was absent. The payer found nothing on file.
CARC 198 means the authorization was exceeded. One existed, but you billed past its visits, units, or dates.
A 197 on a routine in-network therapy code deserves a second look before you write it off. If the payer’s own document says that service needs no authorization, you have grounds to dispute it. Before you appeal, confirm the payer has you loaded as a network provider for behavioral health. Our prior authorization service handles this tracking and the follow-up.
A five-minute check before the first session
Run this on every new patient, even on payers that “never” require authorization. Plan designs change, and employer plans vary.
- Read the card for a carve-out. If it names Carelon, Optum, Evernorth, or another behavioral health administrator, that company holds the authorization rules, not the medical plan.
- Confirm network status for behavioral health specifically. Being in network for the medical plan doesn’t make you in network for its behavioral health administrator.
- Ask about this member’s plan, not the payer in general. “Does routine outpatient psychotherapy require authorization under this member’s plan?”
- Ask about limits and reviews. Visit limits, frequency limits, and any point where the plan starts clinical review.
- Write down the rep’s name and the call reference number. That reference number is your evidence if a 197 shows up later.
Why payers can’t make therapy harder to reach than medical care
Federal mental health parity rules apply to Medi-Cal managed care. DHCS states that treatment limitations on mental health benefits can’t be more restrictive than the main limitations on medical and surgical benefits. Plans also have to apply their authorization policies consistently across medical, mental health, and substance use benefits.
That doesn’t mean every authorization requirement on a therapy service is improper. It does mean you can ask a plan for its utilization management criteria. Medi-Cal plans have to make those criteria available to network providers on request. If you believe a plan is applying stricter rules to therapy than to comparable medical care, raise it with compliance counsel.
How CNB handles authorizations for therapy practices
Claim N Billing started as the in-house billing team for our own family-owned non-emergency medical transportation (NEMT) company. We fixed our own billing failures first, then took that work to other small practices.
For therapists, CNB verifies benefits and authorization rules before the first session, tracks visit counts against any approved authorization, and works 197 and 198 denials back to payment where the documentation supports it.
Read more about how we support behavioral health practices on our mental health billing services page. If you’re also still getting paneled with these plans, our credentialing guide for mental health providers covers that step, and our mental health billing questions post answers the questions therapists ask us most.
Frequently asked questions
Do I need prior authorization for an intake with a Medi-Cal managed care patient?
No, if you’re in the plan’s network. DHCS prohibits Medi-Cal managed care plans from requiring prior authorization or a PCP referral for an initial mental health assessment by a network mental health provider.
Does Magellan still manage behavioral health for Blue Shield of California?
No. Blue Shield took over direct management of behavioral health services on January 1, 2026, for members Magellan used to manage. Send authorization requests to Blue Shield.
Does an approved authorization guarantee the claim pays?
No. Molina’s own authorization form states that authorization doesn’t guarantee payment. The payer can still check eligibility on the date of service, benefit limits, and correct coding.
What if the patient has both Medicare and Medi-Cal?
Bill Medicare first. Medi-Cal requires the Medicare remittance with the claim, and if Medicare denies because its requirements weren’t met, Medi-Cal denies as well.
Get a second set of eyes on your therapy claims
If authorization denials keep showing up on your remittances, CNB will review your recent claims and show you where they’re coming from. Request a free billing audit or call 949-969-4397.