MedicaidPrior AuthMedium impact
25-590m Medical Policies - May 2025
Health Net·CA · Pain Management, Plastic Surgery, ENT (Ear, Nose & Throat) +4 more·Prior Authorization
Effective date
May 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for May 2025, including new coverage restrictions for prolotherapy (now considered insufficient evidence), relaxed requirements for liposuction for lipedema (reduced conservative treatment from 6 to 3 months), and streamlined criteria for nasal valve repair procedures.
Action Required
By May 1, 2025: Billing team must update prior authorization workflows for CalViva Health Medi-Cal members. Stop pursuing prolotherapy authorizations as it's now considered investigational. Update liposuction for lipedema requests to require only 3 months of conservative treatment instead of 6 months. Review nasal valve repair criteria for simplified documentation requirements. Train staff on updated transplant and nitric oxide therapy criteria changes.