MedicaidPrior AuthMedium impact
25-1004m Medical Policies - August 2025
Health Net·CA · Pain Management, Orthopedics, Anesthesiology·Prior Authorization
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Three medical policies were updated for August 2025 affecting pain management procedures and transplant services. Changes include updated criteria for sacroiliac joint interventions, modified requirements for selective nerve root blocks, and revised transplant documentation requirements.
Action Required
By August 1, 2025: Pain management and transplant teams must review updated criteria for CP.MP.166 (Sacroiliac Joint Interventions), CP.MP.165 (Selective Nerve Root Blocks), and CP.MP.247 (Transplant Documentation). Update prior authorization processes to reflect new imaging requirements (fluoroscopic or CT guidance), extended relief period (three months vs two months for nerve blocks), and revised transplant evaluation documentation. Contact CHPIV at 833-236-4141 for clarification on specific criteria changes.