CommercialPrior AuthMedium impact
25-1003m Medical Policies - August 2025
Health Net·CA · Pain Management, Orthopedics, PM&R (Physical Medicine & Rehab) +1 more·Prior Authorization
Effective date
Aug 1, 2025
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated three medical policies for August 2025 affecting pain management procedures. Key changes include requiring fluoroscopic or CT guidance for sacroiliac joint interventions, extending the relief period requirement for nerve blocks from 2 to 3 months, and removing timing restrictions between transforaminal epidural injections.
Action Required
By August 1, 2025: Update prior authorization criteria for sacroiliac joint interventions to require fluoroscopic or CT imaging guidance and include posterior pelvic pain provocation test documentation. For nerve blocks and transforaminal epidural injections, modify authorization protocols to require 3 months (instead of 2) of documented relief and functional improvement, and remove previous timing restrictions between TFESI procedures. Billing team must update system edits and providers should update documentation templates.