Medicare AdvantagePrior AuthHigh impact
24-1257m Review Changes to Medicare Medical Policies - November 2024
Health Net·Gastroenterology, Endocrinology, Pulmonology +6 more·Prior Authorization
Effective date
Nov 1, 2024
We identified it
Jun 20, 2026
Summary
Centene/Health Net has implemented new Medicare prior authorization medical policies and updated existing ones effective November 1, 2024. This includes new policies for GI pathogen testing, pancreatic islet therapy, respiratory viral panel testing, and skin substitutes, plus updates to multiple existing policies covering transplants, genetic testing, and various medical procedures.
Action Required
Immediately: Billing team must review and implement the new prior authorization requirements for the four new policies (GI pathogen nucleic acid testing, Lantidra therapy, PCR respiratory viral panels, and skin/soft tissue substitutes for chronic wounds). Update billing system to flag these services for prior auth verification. Review all updated existing policies including transplant procedures, genetic testing panels, and radiotherapy to ensure current prior auth processes align with revised requirements. Access the Medicare Prior Authorization Medical Clinical Policies page for complete criteria and coding implications.