ExchangeBilling CodesHigh impact
26-580 New Claims Editing Requirements for Established Patient Billing and Bundled Codes
Health Net·CA · Psychiatry·Reimbursement
Effective date
Jun 30, 2026
We identified it
Jun 20, 2026
Summary
Health Net is implementing new claims editing requirements effective June 30, 2026, that will automatically deny claims using incorrect new vs. established patient codes and component codes that should be bundled with comprehensive procedures. The policy particularly affects mental health providers with specific drug testing code bundling rules using a 7-day lookback period.
Action Required
By June 30, 2026: Billing team must update claims review processes to verify patient status before using new patient CPT codes and implement 7-day lookback checks for drug testing codes to prevent bundling violations. Mental health providers must stop billing component codes (80305, 80306, 80307, G0480-G0483) separately when comprehensive codes (G2067-G2075) are used within 7 days for the same patient and provider. Claims violating these edits will be denied with code EXw4.