MedicaidPrior AuthMedium impact
25-1358m Updates to Clinical Policies - November 2025
Health Net·CA · Oncology, Sleep Medicine, PM&R (Physical Medicine & Rehab) +4 more·Prior Authorization
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated multiple clinical policies for November 2025, including changes to prior authorization requirements for electric tumor treating fields, sleep studies, mechanical stretching devices, pediatric oral therapy, skin substitutes, and transplant documentation. Key changes include expanded coverage criteria and new HCPCS codes for various treatments.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements for electric tumor treating fields (lowered performance status from 70 to 60), add new mechanical stretching device codes E1820, E1828, E1829, E1830, E1832 to coverage criteria, and update skin substitute billing to reflect new 4-application initial limit with up to 8 total applications allowed. Remove newly non-covered HCPCS codes A2036-A2039 and Q4383-Q4397 from billing system while restoring Q4104 and Q4106 to preferred product list.