№ files_lp_4_process_1_42308
Form used to request prior authorization for psychological testing under Medi-Cal, detailing client information, testing specifics, diagnostic codes, and hours allowed for evaluation and scoring.
Year: 2026
Region / City: San Diego, California
Document Type: Pre-authorization form
Institution: San Diego Public Sector
Target Audience: Psychologists and healthcare providers
Purpose: Request prior approval for psychological testing under Medi-Cal
Required Information: Client details, psychologist credentials, testing dates, diagnostic information, tests and CPT codes
Processing Time: 14 calendar days from receipt
Referral Source: Child Welfare Services or court-ordered referrals
Clinical Context: Includes case background, purpose of testing, and relevant medical/psychiatric history
Limitations: Psychological testing, test administration, and scoring hours cannot exceed 11 hours total
Fax Number: (866) 220-4495
Phone for Questions: (800) 798-2254 Option #3 then Option #4
Pre-authorization Requirement: Yes
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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