MedicaidCoverageHigh impact
20-712 Medical Policies - 2nd Quarter 2020
Health Net·CA · Cardiology, Neurology, Pulmonology +7 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated medical policies for Q2 2020 affecting Medi-Cal members in Fresno, Kings, and Madera counties. Multiple policies were added or revised with new coverage criteria, code updates, and prior authorization requirements for various procedures including burn surgery, cardiac rehabilitation, genetic testing, and COVID-19 diagnostics.
Action Required
Immediately: Billing team must review and update prior authorization requirements for all affected procedures listed in the policy. Update billing software with new CPT codes for ambulatory EEG (95700, 95705, 95708, 95717, 95719, 95721, 95723, 95725) and mechanical stretching device HCPCS codes (E1800, E1802, E1805, E1810, E1812). Stop billing CPT codes 20560 and 20561 for trigger point injections as they no longer support coverage criteria. Add COVID-19 diagnostic codes U07.1 and U07.2 to system. Contact CalViva Health at 1-888-893-1569 for questions about specific policy requirements.