MedicaidPrior AuthMedium impact
25-732m Medical Policies - June 2025
Health Net·CA · Pain Management, Gastroenterology, Pulmonology +2 more·Prior Authorization
Effective date
Jun 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated medical policies for June 2025 affecting prior authorization and coverage criteria for multiple procedures including epidural injections, facet joint interventions, fecal incontinence treatments, and pulmonary function testing. Key changes include removal of anticoagulation restrictions for epidural procedures, updated physical therapy requirements for facet joint interventions, and expanded coverage criteria for various treatments.
Action Required
By June 1, 2025: Billing team must review and update prior authorization workflows for the affected medical policies including epidural injections (CP.MP.164), facet joint interventions (CP.MP.171), fecal incontinence treatments (CP.MP.137), and pulmonary function testing (CP.MP.242). Update billing system to include new CPT code 44320 and HCPCS codes C1767, C1778 for fecal incontinence treatments, and CPT code 0369U for gastrointestinal pathogen testing. Remove anticoagulation therapy restrictions from epidural steroid injection criteria and update documentation requirements for facet joint interventions.