Medicare AdvantagePrior AuthMedium impact
24-933m Stay Compliant By Reviewing the Changes to Medical Policies for Medicare
Health Net·CA · Pulmonology, Pain Management, Anesthesiology +1 more·Prior Authorization
Effective date
Aug 1, 2024
We identified it
Jun 20, 2026
Summary
Medicare has introduced 4 new clinical policies and updated 1 existing policy for prior authorization requirements, effective August 1, 2024. The changes include new policies for home ventilators, Omisirge medication, outpatient oxygen use, and transplant service documentation, plus additional criteria for peripheral nerve blocks including genicular nerve blocks.
Action Required
Immediately: Review the 5 updated Medicare clinical policies (MC.CP.MP.184, MC.CP.MP.249, MC.CP.MP.190, MC.CP.MP.247, and MC.CP.MP.170) on the Medicare Prior Authorization Medical Clinical Policies page. Billing team must update prior authorization workflows for home ventilators, Omisirge medication, outpatient oxygen use, transplant services, and genicular nerve blocks. Train staff on new criteria III.B. for peripheral nerve blocks. Contact Health Net Provider Services at 800-929-9224 with questions.