MedicaidCoverageMedium impact
25-591m 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
Centene/Health Net has updated multiple medical policies for May 2025, including a new policy stating prolotherapy is not covered due to insufficient evidence, reduced conservative treatment requirements for liposuction and nasal valve repair, and various clarifications to transplant and other specialized procedures.
Action Required
By May 1, 2025: Billing team must update prior authorization requirements for affected procedures. Stop submitting claims for prolotherapy (new non-covered service). Update liposuction for lipedema claims to require only 3 months of conservative treatment (reduced from 6 months). Review and update criteria documentation for nasal valve repair, intestinal transplants, and disc decompression procedures per revised policy guidelines. Verify all affected policies in provider portal for complete coding implications.