MedicaidPrior AuthHigh impact
20-438 Medical Policies - 1st Quarter 2020
Health Net·CA · Orthopedics, Neurology, Pain Management +8 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for Q1 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include new coronavirus testing guidelines, updated DME criteria, revised surgical procedure coverage, and modified prior authorization requirements for various treatments.
Action Required
Immediately: Billing teams must review and update authorization requirements for affected procedures including DME items, facet joint injections, nerve blocks, and transplant services. Update billing system to reflect new coverage criteria for male vacuum erection devices (now covered), cold pad pumps (now not covered), and coronavirus testing per CDC guidelines. Ensure prior authorization is obtained where newly required and verify coverage criteria changes are reflected in encounter forms and billing software.