MedicaidPrior AuthMedium impact
24-401m Medical Policies - March 2024
Health Net·CA · Gastroenterology, OB-GYN, Cardiothoracic Surgery +2 more·Prior Authorization
Effective date
Mar 1, 2024
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for March 2024, including changes to prior authorization requirements for gastric electrical stimulation (now requires age ≥18), expanded OB home program criteria with new medication infusion requirements, and updates to various transplant policies. New HCPCS and CPT codes were added for OB home programs.
Action Required
By March 31, 2024: Billing team must update prior authorization requirements for gastric electrical stimulation to include age verification (≥18 years). Update OB home program billing to include new HCPCS codes G0162, G0299, S9145, S9351, S9353, S9379 and CPT codes 99601, 99602. Verify conservative treatment documentation for medication infusion therapy prior authorizations. Review transplant policy changes for heart-lung, pancreas, stem cell, and tandem transplant criteria updates.