CommercialPrior AuthMedium impact
25-1357m Updates to Clinical Policies - November 2025
Health Net·CA · Transplant Surgery, Wound Care, Oncology +3 more·Prior Authorization
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated multiple clinical policies for November 2025, including changes to prior authorization criteria for electric tumor treating fields, sleep studies, mechanical stretching devices, pediatric oral therapy, skin substitutes, and transplant documentation. Key changes include lowered Karnofsky Performance Status requirements, expanded coverage criteria, and updated HCPCS codes.
Action Required
By November 1, 2025: Billing team must update prior authorization requirements for affected policies. Update billing system to include new HCPCS codes E1820, E1828, E1829, E1830, E1832 for mechanical stretching devices. Remove codes A2036-A2039 and Q4383-Q4397 from skin substitute billing unless patient meets new expanded criteria. Add codes Q4104 and Q4106 back to preferred product list for skin substitutes. Update documentation requirements for transplant services to include consultation requirements.