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Health NetCommercial · Prior Auth · Prior Authorization · CA · General Surgery, Psychiatry, Wound Care +1 moreMedium impact

24-467m Medical Policies - April 2024

Act
immediately
Effective date
Apr 1, 2024
Identified
Jun 20, 2026

Summary

Centene/Health Net updated four medical policies for April 2024, including significant changes to bariatric surgery criteria, deep transcranial magnetic stimulation for OCD, skin and soft tissue substitutes for chronic wounds, and transcranial magnetic stimulation for depression. The changes modify prior authorization requirements, billing codes, and clinical criteria across these specialized procedures.

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What to do

immediately · 4 steps
01Billing teams must update prior authorization requirements for bariatric surgery procedures with revised clinical criteria including new conditions (chronic kidney disease, infertility, polycystic ovarian syndrome) and removed conditions (high-risk diabetes, severe urinary incontinence).
02Update billing software to include new CPT codes 97014 and 97032 for transcranial magnetic stimulation.
03Modify HCPCS code lists for skin substitute products by moving codes A2002, Q4236, Q4262, Q4278 to approved list and adding Q4279, Q4287-Q4304 to non-covered list.
04Remove HCPCS code G0295 from TMS billing.

Codes mentioned

9701497032A2002Q4236Q4262Q4278Q4279Q4287Q4288Q4289Q4290Q4291Q4292Q4293Q4294Q4295Q4296Q4297Q4298Q4299Q4300Q4301Q4302Q4303Q4304G0295

Original notice

24-467m 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 Authorization24-469m Medical Policies - April 2024MediumEffective Apr 1, 2024 · Prior Authorization25-1125m Updates to Medicare Clinical Policies - September 2025MediumEffective Nov 1, 2025 · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesGeneral SurgeryPsychiatryWound CareEndocrinologyCode 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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