CommercialPrior AuthMedium impact
24-467m Medical Policies - April 2024
Health Net·CA · General Surgery, Psychiatry, Wound Care +1 more·Prior Authorization
Effective date
Apr 1, 2024
We identified it
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.
Action Required
Immediately: Billing 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). Update billing software to include new CPT codes 97014 and 97032 for transcranial magnetic stimulation. Modify 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. Remove HCPCS code G0295 from TMS billing.