MedicaidPrior AuthMedium impact
24-1109m Medical Policies - September 2024
Health Net·CA · ENT (Ear, Nose & Throat), Oral & Maxillofacial Surgery, Hematology +2 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated three medical policies for September 2024, adding new prior authorization requirements for hypoglossal nerve stimulation procedures and modifying criteria for allogeneic hematopoietic cell transplant and orthognathic surgery. Two policies for Ferriscan R2-MRI and ultrafiltration for heart failure were retired.
Action Required
Immediately: Update billing system to require prior authorization for drug induced sleep endoscopy (CPT 42975) when evaluating appropriateness of hypoglossal nerve stimulation devices. Review and update criteria for orthognathic surgery claims (4mm threshold change) and allogeneic hematopoietic cell transplant procedures. Stop using retired policies for Ferriscan R2-MRI and ultrafiltration for heart failure. Contact CalViva Health at 888-893-1569 with questions.