CommercialBilling CodesMedium impact
25-175m Medical Policies - January 2025
Health Net·CA · PM&R (Physical Medicine & Rehab), Pain Management, Oncology +4 more·Prior Authorization
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
Eight medical policies were updated effective January 2025, including expanded criteria for proton beam therapy, updated DME equipment codes, revised biofeedback treatment requirements, and modified criteria for hyperhidrosis treatments, pain pumps, sleep apnea devices, urinary incontinence treatments, and outpatient oxygen use.
Action Required
By January 31, 2025: Billing team must update DME coding in billing system - replace K1032 and K1033 with E0678 and E0679 for compression devices, add L2006 for microprocessor knee-ankle-foot orthoses, remove L4130 for shoulder/elbow orthotics, change E2300 to E2298 for power wheelchair seat elevators, and add E0447 for oxygen equipment. Update prior authorization workflows for expanded proton beam therapy criteria and revised biofeedback session limits.