MedicaidPrior AuthMedium impact
24-402m Medical Policies - March 2024
Health Net·CA · Gastroenterology, OB-GYN, Cardiothoracic Surgery +4 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
Centene/Community Health Plan of Imperial Valley updated multiple prior authorization policies effective March 2024, including changes to gastric electrical stimulation (now requires age ≥18), OB home programs with new medication infusion criteria, and several transplant policies. New billing codes were added for OB home programs including G0162, G0299, S9145, S9351, S9353, S9379, 99601, and 99602.
Action Required
Immediately: Billing team must update prior authorization requirements for gastric electrical stimulation to verify patients are ≥18 years old. For OB home programs, add new HCPCS codes G0162, G0299, S9145, S9351, S9353, S9379 and CPT codes 99601, 99602 to billing system. Update prior auth workflows to include new medication infusion therapy criteria requiring documentation of failed conservative treatments. Contact Community Health Plan at 833-236-4141 for questions.