A Medi-Cal TAR, or Treatment Authorization Request, is the approval a provider must get from the state before delivering certain non-emergency services under fee-for-service Medi-Cal. Without an approved TAR, the state will not reimburse the provider, and the service is usually delayed or dropped. The process runs on specific forms, diagnosis and procedure codes, and documented proof that the service is medically necessary under California regulations. As of January 1, 2026, standard TAR decisions must come within seven calendar days rather than the previous thirty.
Who This Applies To
The TAR process covers fee-for-service Medi-Cal, sometimes called “regular” Medi-Cal, where the state pays providers directly for each covered service. Most Medi-Cal members are enrolled in managed care plans, and those plans run their own prior authorization systems with their own forms and portals. If you are in a managed care plan, call the plan directly about authorization requirements. Everything below is specific to fee-for-service.
Which Services Need a TAR
Routine office visits, basic lab work, and preventive screenings usually go through without prior authorization. Services that do need a TAR tend to be elective or specialized: certain surgical procedures, durable medical equipment, specific medications, some imaging studies, inpatient hospital stays beyond emergency stabilization, and procedures classified as non-standard benefits. Medi-Cal publishes code lists that spell out which CPT and HCPCS codes require a TAR, organized by code range and updated periodically.1Medi-Cal. TAR and Non-Standard Benefits List Codes 10000 Through 19999 Providers check those lists before submitting. If the code is not on the TAR-required list, the provider bills directly and the claim goes through standard utilization review afterward.
What Has to Be in the Submission
Every TAR has to show that the service is medically necessary. Title 22, Section 51303 of the California Code of Regulations defines that standard: the service must be reasonable and necessary to protect life, prevent significant illness or disability, or relieve severe pain through diagnosis or treatment.2Legal Information Institute. California Code of Regulations Title 22 Section 51303 – General Provisions The same regulation requires “fully documented medical justification.” A general statement that the patient needs the service is not enough. The provider has to supply clinical evidence from the patient’s records that ties the diagnosis to the specific treatment requested.
Title 22, Section 51003 governs how the Department of Health Care Services (DHCS) reviews TARs and confirms that each submission is judged on medical necessity alone. The provider must explain why the service is necessary or attach documentation that makes the case.3Legal Information Institute. California Code of Regulations Title 22 Section 51003 – Treatment Authorization Requests
Along with the clinical records, every submission needs the member’s Medi-Cal ID number, ICD-10 diagnosis codes that identify the condition, and CPT or HCPCS codes for the procedure or equipment. A wrong code is one of the quickest routes to a denial or deferral, so providers check codes against Medi-Cal’s billing references before sending anything in.
Which Form to Use
Medi-Cal uses different TAR forms for different services, and the wrong form comes back rejected.
- Form 50-1 is the standard form for most medical and pharmacy services and covers the majority of submissions.4Medi-Cal. Medi-Cal Treatment Authorization Request TAR Overview
- Form 18-1 is used only by hospitals to request authorization for inpatient days, including emergency admissions and extensions of stay. Physicians billing for procedures done during a hospital stay still use the 50-1.5Medi-Cal. Medi-Cal TAR Request for Extension of Stay in Hospital Form 18-1
- Form 20-1 is used by nursing facilities for long-term care authorization.4Medi-Cal. Medi-Cal Treatment Authorization Request TAR Overview
- Form 50-3 is used by vision care providers to request authorization through the DHCS Vision Services Branch.6Medi-Cal. TAR Completion for Vision Care
All forms are on the Medi-Cal provider website. Filling every required field correctly heads off the clerical rejections that force a restart.
Submitting and Tracking the Request
Providers can submit a completed TAR through the electronic e-TAR portal on the Medi-Cal website, by mail to the local Medi-Cal field office, or by fax. The e-TAR portal is the fastest option and lets providers create, update, and check the status of requests in real time.4Medi-Cal. Medi-Cal Treatment Authorization Request TAR Overview Paper mail is slower. Fax sits in the middle.
Once DHCS receives the request, it generates a tracking number that becomes the reference point for every follow-up. A DHCS consultant then reviews the medical records, diagnosis codes, and supporting documentation against the regulatory standard for medical necessity.
Decision Timelines Starting in 2026
The CMS Interoperability and Prior Authorization final rule (CMS-0057-F) shortened the maximum response window for Medicaid fee-for-service prior authorization decisions starting January 1, 2026. Standard TAR requests must be decided within seven calendar days, down from thirty. Expedited requests for urgent medical needs must be decided within seventy-two hours.7Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule CMS-0057-F
The seven-day window can be extended by up to fourteen additional calendar days if the beneficiary or provider asks for an extension, or if the payer justifies needing more information and explains how the delay serves the beneficiary’s interest. One limit worth knowing: these federal timelines do not apply to drug-related prior authorizations. Prescription drugs, whether self-administered or dispensed at a pharmacy or hospital, remain under existing state timelines.7Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule CMS-0057-F
Emergency Admissions
Emergency hospital admissions do not wait for a TAR. Federal law under EMTALA requires the hospital to screen and stabilize the patient regardless of insurance status or prior authorization.8Centers for Medicare & Medicaid Services. Emergency Medical Treatment and Labor Act EMTALA The hospital then files an 18-1 TAR after the fact to request authorization for the days of the emergency stay.5Medi-Cal. Medi-Cal TAR Request for Extension of Stay in Hospital Form 18-1
DHCS consultants review retroactive hospital TARs by looking at discharge summaries alongside the rest of the medical record.4Medi-Cal. Medi-Cal Treatment Authorization Request TAR Overview If the admission does not meet the regulatory definition of an emergency under Title 22, Section 51056, the consultant can deny the admission day and everything billed for it, including emergency room charges, diagnostics, and surgical services.5Medi-Cal. Medi-Cal TAR Request for Extension of Stay in Hospital Form 18-1 Thorough documentation at admission is what protects that reimbursement. If the hospital needs more days than were originally authorized, it files another 18-1 extension TAR before the authorized days run out.
The Four Possible Decisions
A TAR review closes with one of four outcomes.
- Approved. The provider can deliver the service and bill Medi-Cal for reimbursement. No claim should be submitted before the TAR is approved for elective services.9Medi-Cal. Medi-Cal Treatment Authorization Request TAR Process and Requirements
- Denied. The request did not meet clinical or administrative standards, and the provider cannot bill for the service. DHCS sends the member a Notice of Action explaining the reason and how to appeal.9Medi-Cal. Medi-Cal Treatment Authorization Request TAR Process and Requirements
- Modified. DHCS authorizes only part of the original request, such as fewer sessions, a smaller quantity, or a shorter duration. The provider can bill only for what the modified approval covers.
- Deferred. The consultant needs more information. The review pauses until the provider sends the missing records, corrected codes, or added clinical documentation. A deferral is not a denial, but it resets the clock, so a fast response matters.
An approved TAR is not a guarantee of final payment. DHCS can conduct retrospective review after services are delivered and deny reimbursement if what was billed does not match what was authorized, or if the original approval rested on incomplete or inaccurate information.
Appealing a Denial
When DHCS denies or modifies a TAR, the member gets a Notice of Action with the decision, the reason, and instructions for requesting a state hearing. Under Welfare and Institutions Code Section 10950, any Medi-Cal recipient who disagrees with a coverage decision can request a hearing before an Administrative Law Judge.10Justia. California Code Welfare and Institutions Code 10950-10967 – Hearings You can represent yourself or bring an attorney, friend, or other representative.
The deadline is ninety days from the date the Notice of Action was mailed. After that, you generally lose the right to challenge that decision unless you can show good cause for filing late. Requests can go to the California Department of Social Services State Hearings Division or to the county welfare department at the address on the Notice of Action.11California Department of Social Services. Hearing Requests At the hearing, the judge evaluates whether the denial complied with California law and the medical necessity standard, and can order DHCS to authorize the service. The written decision is binding on the state.
Keeping Benefits Going During the Appeal
If DHCS is reducing, suspending, or ending a service you are already receiving, timing your hearing request matters. Under California law, if you request the hearing before the effective date on the Notice of Action, you may be entitled to continue receiving the service until the hearing is resolved.10Justia. California Code Welfare and Institutions Code 10950-10967 – Hearings This is sometimes called “aid paid pending.” Miss that window and the service stops while you wait, which can be weeks. For ongoing treatment, those weeks are the point.
Interpreters and Language Access
If you have limited English proficiency, federal law requires free language assistance throughout the hearing process. Under 45 CFR Section 92.201, covered entities must provide qualified interpreters and translated materials at no cost. The program cannot ask you to bring your own interpreter, cannot rely on minor children to interpret except in genuine emergencies, and cannot charge you for translation.12eCFR. 45 CFR 92.201 – Meaningful Access for Individuals With Limited English Proficiency If remote video or phone interpreting is used, the connection must be high-quality and real-time. Ask for interpreter services when you file the hearing request so arrangements are in place before your hearing date.