All PlansPrior AuthMedium impact
24-1347m Medical Policies - November 2024
Health Net·CA · Oncology, Sleep Medicine, Radiation Oncology +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated three medical policies for November 2024: lowered Karnofsky Performance Status requirement for Electric Tumor Treatment Fields from ≥60 to ≥70, modified sleep study criteria including adding hypertension as a qualifying diagnosis, and expanded Stereotactic Body Radiation Therapy coverage for spinal tumors. They also retired the Transcatheter Closure of Patent Foramen Ovale policy.
Action Required
Immediately: Update prior authorization workflows for Electric Tumor Treatment Fields to require Karnofsky Performance Status ≥70 instead of ≥60. For sleep studies, add hypertension as qualifying diagnosis and remove Epworth Sleepiness Scale requirements. Update authorization criteria for spinal tumor radiation therapy to include all spinal tumors (not just inoperable ones). Stop processing prior authorizations for Transcatheter Closure of Patent Foramen Ovale as this policy is retired.