MedicaidPrior AuthMedium impact
24-1108m Medical Policies - September 2024
Health Net·CA · ENT (Ear, Nose & Throat), Oral & Maxillofacial Surgery, Sleep Medicine +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated three medical policies for September 2024, adding new prior authorization criteria for hypoglossal nerve stimulation procedures and modifying coverage criteria for stem cell transplants and orthognathic surgery. Two policies were retired including Ferriscan R2-MRI and ultrafiltration for heart failure.
Action Required
Immediately: Update prior authorization workflows to require drug induced sleep endoscopy (DISE) evaluation before hypoglossal nerve stimulation device procedures using CPT 42975. Review orthognathic surgery criteria - the mandibular deficiency threshold changed from 'greater than 4mm' to '4mm or greater'. Stop billing for retired Ferriscan R2-MRI and ultrafiltration procedures as they are no longer covered.