CommercialPrior AuthMedium impact
25-592m Medical Policies - May 2025
Health Net·CA · Plastic Surgery, ENT (Ear, Nose & Throat), Gastroenterology +6 more·Prior Authorization
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated multiple medical policies for May 2025, including a new policy denying prolotherapy coverage, relaxed requirements for liposuction for lipedema (reducing conservative treatment from 6 to 3 months), simplified nasal valve repair criteria, and various updates to transplant and other specialty procedures.
Action Required
By May 1, 2025: Billing team must update prior authorization requirements for affected procedures. Stop seeking authorization for prolotherapy (now non-covered). Update liposuction for lipedema documentation requirements to require only 3 months of conservative treatment instead of 6 months. Review and update criteria documentation for nasal valve repair procedures per simplified requirements. Contact Health Net Provider Services for specific billing code impacts at 800-641-7761.