MedicaidPrior AuthMedium impact
25-1124m Updates to Clinical Policies - September 2025
Health Net·CA · Dermatology, Oncology, Hematology +3 more·Prior Authorization
Effective date
Sep 1, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated five clinical policies effective September 2025, including new coverage for radiation therapy for skin cancer and removing age limits for stem cell transplants. Key changes include adding specific HCPCS codes for compression devices and clarifying prior authorization criteria across multiple specialties.
Action Required
By September 1, 2025: Billing team must update prior authorization workflows for the five updated policies (CP.MP.251, CP.MP.108, CP.MP.107, CP.MP.202, CP.MP.138). Add HCPCS codes E0680 and E0681 to compression device billing options. Review documentation requirements for pediatric heart transplant claims (removed BMI restrictions). Contact CalViva Health at 888-893-1569 with questions before implementation.