CommercialPrior AuthMedium impact
23-1338m Medical Policies - October 2023
Health Net·CA · Cardiology, OB-GYN, Family Medicine +3 more·Prior Authorization
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Health Net updated prior authorization criteria for four medical policies effective October 2023, including expanded coverage for Holter monitors (now covering baseline screening for adult congenital heart disease), revised genitourinary testing criteria (lowering age to 16+ and adding new covered DNA probe tests), added hyperparathyroidism as covered indication for Vitamin D testing, and simplified varicose vein sclerotherapy requirements.
Action Required
Immediately: Update prior authorization protocols for Holter monitor requests to include baseline screening for adult congenital heart disease patients and verify FDA-approved devices. Update age criteria for genitourinary testing from 18+ to 16+ years and add new covered CPT codes 81513, 81514, 87511, and 0352U to billing system as medically necessary. Add hyperparathyroidism (ICD-10 codes E89.2, M83.8, M83.9) as covered indication for Vitamin D testing. Remove ultrasound positioning requirements for varicose vein sclerotherapy prior authorizations.