CommercialBilling CodesMedium impact
25-348 Avoid Unnecessary Denials and Claims Processing Delays by Following These Payment Policies
Health Net·CA · Urology, Ophthalmology, Emergency Medicine·Reimbursement
Effective date
Jun 27, 2025
We identified it
Jun 20, 2026
Summary
Health Net is implementing new payment edits effective June 27, 2025, including strict ambulance place of service coding requirements and updated medical necessity criteria for urodynamic testing and fundus photography. Claims not meeting these requirements will be denied.
Action Required
By June 27, 2025: Billing team must update system to enforce correct ambulance place of service codes - Location 41 (Urban) for codes A0425-A0429, A0432-A0434 and Location 42 (Rural) for codes A0430-A0431, A0435-A0436. Review and update billing protocols for urodynamic testing and fundus photography to ensure medical necessity documentation meets Health Net requirements. Claims with incorrect POS coding or insufficient medical necessity will be denied.