CommercialPrior AuthMedium impact
24-1107m Medical Policies - September 2024
Health Net·CA · Hematology, ENT (Ear, Nose & Throat), Sleep Medicine +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated three medical policies in September 2024: added criteria for Casgevy® in sickle cell transplants, added drug-induced sleep endoscopy requirements for hypoglossal nerve stimulation devices, and modified orthognathic surgery criteria including changing the measurement threshold from >4mm to ≥4mm.
Action Required
Immediately: Billing team must update prior authorization procedures for three policies - (1) add Casgevy® criteria notes for sickle cell transplant cases, (2) require drug-induced sleep endoscopy evaluation before approving hypoglossal nerve stimulation devices using new CPT 42975, and (3) update orthognathic surgery criteria to include 4mm threshold (previously >4mm) and soft tissue irritation documentation. Contact Health Net Provider Services at appropriate line of business numbers for questions.