MedicaidCoverageHigh impact
21-792 Medical Policies - 3rd Quarter 2021
Health Net·CA · General Surgery, Pain Management, Gastroenterology +7 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated 21 medical policies in Q3 2021 affecting prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include new non-covered bariatric procedures, revised pain management criteria, updated NICU guidelines, and modified therapy requirements for skilled nursing facilities.
Action Required
Immediately: Update billing systems to flag CPT codes 43648, 43882, 64595, 0312T, 0313T, 0314T, 0315T, 0316T, and 0317T as non-covered for bariatric procedures. Update HCPCS code E0744 as non-covered for neuromuscular stimulation. Add ICD-10 codes K86.0 and K86.1 to support celiac plexus block coverage. Review all 21 updated policies on provider website for complete criteria changes. Failure to comply may result in claim denials.