CommercialPrior AuthMedium impact
24-403m 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/Health Net updated multiple medical policies for March 2024, including new prior authorization criteria for gastric electrical stimulation (now requires age 18+), expanded OB home program coverage with new medication infusion therapy requirements, and updates to several transplant policies. New HCPCS and CPT codes were added for OB home programs.
Action Required
Immediately: Billing teams must update prior authorization workflows for gastric electrical stimulation to verify patients are 18+ years old before submitting requests. Update billing systems to include new HCPCS codes G0162, G0299, S9145, S9351, S9353, S9379 and CPT codes 99601, 99602 for OB home programs. Providers must document failed conservative treatments before requesting medication infusion therapy authorization for OB patients.