CommercialPrior AuthMedium impact
25-1122m Updates to Clinical Policies - September 2025
Health Net·CA · Hematology, Oncology, Oral & Maxillofacial Surgery +3 more·Prior Authorization
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated five clinical policies effective September 2025, including removal of age limits for sickle cell transplants, addition of HCPCS codes E0680 and E0681 for compression devices, and creation of a new radiation therapy policy for skin cancer. These changes primarily affect prior authorization requirements and coverage criteria.
Action Required
By September 1, 2025: Update billing system to include new HCPCS codes E0680 and E0681 for non-pneumatic compression devices. Review prior authorization workflows for allogeneic hematopoietic cell transplants (no longer require age limits for sickle cell disease) and pediatric heart transplants (BMI criteria removed). Add new radiation therapy for skin cancer to covered services list.