MedicaidCoverageMedium impact
20-947 Medical Policies - 3rd Quarter 2020
Health Net·CA · Pain Management, Infectious Disease, Pulmonology +4 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
This is a quarterly medical policy update from CalViva Health affecting Medi-Cal members in Fresno, Kings and Madera counties. Multiple policies were updated including new criteria for COVID-19 testing, respiratory viral panels, nerve blocks, and various surgical procedures with specific billing code changes.
Action Required
Immediately: Billing teams serving Medi-Cal patients in Fresno, Kings and Madera counties must review the complete policy document at the Provider Library to understand specific medical necessity criteria changes. Update billing system rules for the listed procedure codes, particularly noting that codes 0213T-0218T for ultrasound-guided facet injections are now investigational and codes E1399, E1801, E1806, E1811, E1815, E1816, E1818, E1830, E1831, E1840, E1841 for stretching devices do not support medical necessity.