CommercialPrior AuthMedium impact
25-730m Medical Policies - June 2025
Health Net·CA · Pain Management, Gastroenterology, Pulmonology +3 more·Prior Authorization
Effective date
Jun 1, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated 11 medical policies for June 2025, including changes to prior authorization criteria for procedures like epidural steroid injections, facet joint interventions, fecal incontinence treatments, and several other specialty procedures. Most changes involve modified medical necessity criteria and updated coverage requirements.
Action Required
By June 1, 2025: Review and update prior authorization protocols for affected procedures including epidural steroid injections (CP.MP.164), facet joint interventions (CP.MP.171), and fecal incontinence treatments (CP.MP.137). Billing team must update system to include new CPT 44320 and HCPCS codes C1767, C1778 for fecal incontinence procedures, and CPT 0369U for GI pathogen testing. Providers should review updated medical necessity criteria for pulmonary function testing, reduction mammoplasty, and pediatric liver transplant cases.