All PlansPrior AuthHigh impact
22-730 Wound Care With Visit Limits Requires Prior Authorization
Health Net·CA · Wound Care, Oncology, Ophthalmology +1 more·Prior Authorization
Effective date
Oct 1, 2022
We identified it
Jun 20, 2026
Summary
Effective October 1, 2022, wound care and wound debridement require prior authorization after 12 visits per calendar year. Additionally, several new Part B medications now require immediate prior authorization, including multiple injection codes for cancer treatments, immune therapies, and other specialty medications.
Action Required
Immediately: Billing team must update prior authorization tracking system to flag wound care and wound debridement visits after the 12th visit per calendar year. Update billing software to require prior authorization for all listed Part B medication codes (C9094-C9098, J0739, J1306, J1551, J2356, J2779, J2998, J3299, J9331, J9332). Train providers to obtain prior auth before administering these medications. Use the Health Net Prior Authorization Tool to verify current requirements for all CPT/HCPCS codes.