Medicare AdvantagePrior AuthMedium impact
23-1011 Summary Update: Changes to Prior Authorization Requirements
Health Net·CA · Dermatology, Endocrinology, OB-GYN +5 more·Prior Authorization
Effective date
Oct 2, 2023
We identified it
Jun 20, 2026
Summary
Wellcare By Health Net is removing prior authorization requirements for over 300 codes effective October 2, 2023, including dermatology procedures, DME, and diagnostic imaging, while adding PA requirements for two Part B injection drugs (J1950, J9214). Additional Part B medications also required PA starting July 1, 2023.
Action Required
By October 2, 2023: Billing team must update prior authorization requirements in billing system - remove PA requirements for dermatology skin tag removal, continuous glucose monitoring DME, flap procedures, most hysterectomies, thyroid/parathyroid imaging, bone marrow imaging, liver/spleen/gallbladder imaging, bone marrow culture, and neurology testing. Add PA requirements for CPT J1950 (leuprolide acetate injection) and J9214 (interferon alfa-2b injection). Use the online prior authorization tool to verify current PA requirements for all codes. Claims may be denied if PA requirements are not properly followed.