CommercialPrior AuthMedium impact
24-468m Medical Policies - April 2024
Health Net·CA · General Surgery, Psychiatry, Wound Care +1 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Centene updated multiple medical policies for April 2024, including significant changes to bariatric surgery criteria, transcranial magnetic stimulation requirements, and skin substitute coverage guidelines. Key changes include modified eligibility criteria for bariatric surgery, updated billing codes for various treatments, and clarified documentation requirements.
Action Required
Immediately: Billing team must review and update prior authorization requirements for bariatric surgery procedures, ensuring new eligibility criteria are met including updated comorbidity requirements. Update billing system to include new CPT codes 97014 and 97032 for transcranial magnetic stimulation. For wound care billing, verify that skin substitute claims use only the approved HCPCS codes from the updated medical necessity criteria tables and stop using removed codes G0295 for TMS procedures.