MedicaidPrior AuthMedium impact
25-1123m Updates to Clinical Policies - September 2025
Health Net·CA · Oncology, Hematology, Oral & Maxillofacial Surgery +4 more·Prior Authorization
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net California updated multiple clinical policies for September 2025, including new radiation therapy coverage for skin cancer, expanded eligibility for sickle cell transplants by removing age limits, and added new HCPCS codes for non-pneumatic compression devices. Several policies had criteria clarifications for orthognathic surgery and pediatric heart transplantation.
Action Required
By September 1, 2025: Billing team must update system to include new HCPCS codes E0680 and E0681 for non-pneumatic compression devices. Review updated prior authorization criteria for allogeneic hematopoietic cell transplants (removed age limits), orthognathic surgery, and pediatric heart transplantation. Update encounter forms and authorization workflows to reflect relaxed eligibility requirements for sickle cell disease transplants.