Medicare AdvantagePrior AuthHigh impact
21-790 Medical Policies - 3rd Quarter 2021
Health Net·CA · Pain Management, Gastroenterology, Radiology +8 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated 25+ medical policies in Q3 2021 affecting prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include relaxed bariatric surgery requirements, new non-covered procedures with specific CPT codes, updated therapy guidelines, and revised documentation requirements for various services.
Action Required
Immediately: Billing teams must update prior authorization workflows and billing systems to reflect multiple policy changes. Stop billing CPT codes 43648, 43882, 64595, 0312T-0317T for bariatric procedures as they no longer support medical necessity. Update HCPCS code E0744 as non-covered for neuromuscular stimulation. Add ICD-10 codes K86.0 and K86.1 for celiac plexus block coverage. Review and update encounter forms for affected specialties including bariatric surgery, pain management, physical therapy, and NICU services. Failure to update systems may result in claim denials.