MedicaidPrior AuthMedium impact
25-1005m Medical Policies - August 2025
Health Net·CA · Pain Management, Orthopedics, Anesthesiology +1 more·Prior Authorization
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated three medical policies for August 2025, affecting sacroiliac joint interventions, nerve root blocks/epidural injections, and transplant documentation. Key changes include requiring fluoroscopic/CT imaging guidance for sacroiliac procedures, extending relief/improvement evaluation period from 2 to 3 months for epidural injections, and removing specific HLA documentation requirements for transplants.
Action Required
By August 1, 2025: Billing team must update prior authorization requirements for sacroiliac joint interventions to ensure fluoroscopic or CT imaging guidance is documented. Update criteria for nerve root blocks to reflect 3-month (instead of 2-month) evaluation periods for relief and functional improvement. Remove anticoagulation therapy as a mandatory criterion and note it separately. Update transplant evaluation documentation by removing HLA-specific requirements from policy CP.MP.247.