All PlansCoverageHigh impact
20-219 Medical Policies - 4th Quarter 2019
Health Net·CA · Gastroenterology, Plastic Surgery, Vascular Surgery +9 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated 22 medical policies in Q4 2019, including new policies for Antithrombin III treatment, implantable hypoglossal nerve stimulation, and video EEG monitoring. Key changes include lowered colorectal cancer screening age to 45, updated bariatric surgery criteria, and multiple billing code additions/removals across various specialties.
Action Required
Immediately: Billing team must update systems to reflect multiple policy changes: 1) Lower age requirement for colorectal cancer screening from 50 to 45 years, 2) Remove codes 64560 and 64563 for hyperhidrosis treatments and add codes 11450 and 11451, 3) Add codes 36482 and 36483 to non-covered services for varicose vein treatments, 4) Update prior authorization requirements for new policies on Antithrombin III, hypoglossal nerve stimulation, and video EEG monitoring, 5) Review and update encounter forms with new ICD-10 codes for gender affirming procedures, urodynamic testing, and wheelchair seating. Claims may be denied if outdated codes or criteria are used.