Medicare AdvantagePrior AuthMedium impact
23-1405 New CMS HCPCS Codes and Prior Authorization Changes
Health Net·CA · Palliative Care, Oncology, Nephrology +1 more·Prior Authorization
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Wellcare By Health Net is requiring prior authorization for palliative care services for D-SNP members starting January 1, 2024, and adding prior authorization requirements for 9 new Part B medications with specific HCPCS codes effective October 1, 2023. The newly FDA-approved medication Elevidys also requires prior authorization immediately.
Action Required
By January 1, 2024: Billing team must update prior authorization workflows to require PA for palliative care services for D-SNP members only. By October 1, 2023: Update billing system to require prior authorization for the 10 specified HCPCS codes (C9155, C9157, J0801, J0802, J0889, J2781, J7214, J9051, J9064, J9345) and Elevidys medication. Contact Provider Services at 800-929-9224 with questions. Claims submitted without required prior authorization will be denied.