MedicaidPrior AuthMedium impact
25-472m Medical Policies - April 2025
Health Net·CA · Cardiology, Vascular Surgery, Dermatology +4 more·Prior Authorization
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated six medical policies for April 2025, including expanded air ambulance coverage to include water ambulances, enhanced behavioral health documentation requirements, revised criteria for heart procedure devices, updated varicose vein treatment requirements, completely restructured skin substitute criteria with a new preferred product list, and added post-transplant follow-up documentation requirements.
Action Required
By April 1, 2025: Billing teams must review and update prior authorization workflows for the six updated policies (CP.MP.175, CP.BH.500, CP.MP.147, CP.MP.146, CP.MP.185, CP.MP.247). Access the full policy details at Medical Policies section on provider portal to understand specific criteria changes. Update encounter forms and EMR templates to reflect new documentation requirements, especially for behavioral health services and transplant follow-up visits. Train staff on revised criteria for percutaneous left atrial appendage closure devices and skin substitute products with new preferred product list.