MedicaidCoverageHigh impact
24-918 Avoid Unnecessary Claims Denials and Processing Delays for In-Office Lab Testing
Health Net·CA·Reimbursement
Effective date
Nov 11, 2024
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health now restricts in-office lab testing to only STAT (emergency/urgent) procedures effective November 11, 2024. Non-STAT lab tests must be referred to contracted independent labs, while sensitive services testing can continue in-office.
Action Required
Immediately: Review current in-office lab billing practices and identify which tests qualify as STAT procedures per the policy's approved code list. Stop billing non-STAT lab procedures for in-office testing and establish referral process to contracted independent labs. Update staff workflows to distinguish between STAT, sensitive services, and routine lab testing. Claims for non-approved in-office lab tests will be denied.