MedicaidPrior AuthMedium impact
24-469m Medical Policies - April 2024
Health Net·CA · General Surgery, Psychiatry, Wound Care·Prior Authorization
Effective date
Apr 1, 2024
We identified it
Jun 20, 2026
Summary
CalViva Health updated four medical policies for April 2024, including significant changes to bariatric surgery criteria, transcranial magnetic stimulation requirements, and skin substitute coverage. Multiple CPT and HCPCS codes were added or modified across these policies, particularly affecting prior authorization requirements.
Action Required
Immediately: Billing teams in Fresno, Kings, and Madera counties must review updated prior authorization criteria for bariatric surgery, transcranial magnetic stimulation, and skin substitute procedures. Update billing system rules for new HCPCS codes Q4278, Q4279, and Q4287-Q4304. Ensure proper documentation requirements are met for TMS therapy including pre-treatment depression scores. Verify eligibility and prior auth status through CalViva Health provider portal before submitting claims.