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Health NetMedicaid · Prior Auth · Prior Authorization · CA · General Surgery, Psychiatry, Wound CareMedium impact

24-469m Medical Policies - April 2024

Act
immediately
Effective date
Apr 1, 2024
Identified
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.

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What to do

immediately · 4 steps
01Billing teams in Fresno, Kings, and Madera counties must review updated prior authorization criteria for bariatric surgery, transcranial magnetic stimulation, and skin substitute procedures.
02Update billing system rules for new HCPCS codes Q4278, Q4279, and Q4287-Q4304.
03Ensure proper documentation requirements are met for TMS therapy including pre-treatment depression scores.
04Verify eligibility and prior auth status through CalViva Health provider portal before submitting claims.

Codes mentioned

9701497032A2002Q4236Q4262Q4278Q4279Q4287Q4288Q4289Q4290Q4291Q4292Q4293Q4294Q4295Q4296Q4297Q4298Q4299Q4300Q4301Q4302Q4303Q4304G0295

Original notice

24-469m Medical Policies - April 2024
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related changes

See all Health Net changes →
24-468m Medical Policies - April 2024MediumNo effective date · Prior Authorization24-467m Medical Policies - April 2024MediumEffective Apr 1, 2024 · Prior Authorization25-1125m Updates to Medicare Clinical Policies - September 2025MediumEffective Nov 1, 2025 · Prior Authorization20-712 Medical Policies - 2nd Quarter 2020HighNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesGeneral SurgeryPsychiatryWound CareCode 97014Code 97032Code A2002Code Q4236Code Q4262Code Q4278Code Q4279Code Q4287Code Q4288Code Q4289Code Q4290Code Q4291Code Q4292Code Q4293Code Q4294Code Q4295Code Q4296Code Q4297Code Q4298Code Q4299Code Q4300Code Q4301Code Q4302Code Q4303Code Q4304Code G0295

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