All PlansCoverageHigh impact
20-437 Medial Policies - 1st Quarter 2020
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated multiple medical policies in Q1 2020, including new prior authorization requirements, coverage changes for various procedures, and updated billing codes. Key changes include new coronavirus testing guidelines, revised DME criteria, and updated coverage for procedures like facet joint injections and nerve blocks.
Action Required
Immediately: Billing team must update systems to reflect multiple policy changes including: 1) Remove CPT 38206 for allogeneic transplants, 2) Mark CPT codes 64625 and 64451 as not medically necessary for sacroiliac joint interventions, 3) Add CPT codes 0587T-0590T as investigational for tibial nerve stimulation, 4) Update DME coverage criteria removing E1399 for gait trainers while adding it for wheelchair repairs, 5) Update ICD-10 codes including new R06.2 for allergy testing. Review complete policy document for all coverage criteria changes to prevent claim denials.