MedicaidPrior AuthHigh impact
25-174m Medical Policies - January 2025
Health Net·CA · PM&R (Physical Medicine & Rehab), Pain Management, Oncology +4 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Centene/Health Net updated multiple prior authorization policies for January 2025, including expanded criteria for proton beam therapy, updated DME codes, and revised requirements for hyperhidrosis treatments, pain pumps, and biofeedback services. Key changes include new billing codes for compression devices and microprocessor knee orthotics.
Action Required
Immediately: Update billing system to replace DME codes K1032 and K1033 with E0678 and E0679 for non-pneumatic compression devices. Add new code L2006 for microprocessor knee orthotics. Remove code L4130 for upper extremity orthotics. Update power wheelchair code from E2300 to E2298. Add oxygen equipment code E0447. Review prior authorization requirements for proton beam therapy expanded indications including intraocular melanomas, spinal tumors, and new cancer types.