CommercialCoverageHigh impact
20-217 Medical Policies - 4th Quarter 2019
Health Net·CA · General Surgery, Gastroenterology, Pain Management +8 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated 25+ medical policies in Q4 2019 with significant changes to prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include updated bariatric surgery criteria, new DNA stool screening age range (45-85), added prior authorization requirements for various procedures, and terminology updates for gender-affirming procedures.
Action Required
Immediately: Billing teams must update prior authorization workflows for all affected procedures including bariatric surgery, DNA stool screening, nerve blocks, and gender-affirming procedures. Update billing software to reflect new age criteria for colorectal screening (45-85 years), revised HbA1C requirements for bariatric surgery (<7%), and new medical necessity codes. Review all 25+ updated policies at provider.healthnet.com under Clinical > Medical Policies to ensure compliance with new coverage criteria.