MedicaidCoverageMedium impact
23-1340m Medical Policies - October 2023
Health Net·CA · Cardiology, OB-GYN, Urology +2 more·Prior Authorization
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for October 2023, including changes to Holter monitor criteria (expanding age requirements and adding cardiomyopathy conditions), genitourinary testing (lowering age to 16+ and adding new covered DNA probe tests), sclerotherapy criteria, and vitamin D measurement indications. Several CPT codes moved from non-covered to covered status.
Action Required
Immediately: Update billing system to reflect new covered CPT codes 81513, 81514, 87511, and 0352U for genitourinary DNA probe testing for patients 16+ years old. Update prior authorization requirements for Holter monitors to specify FDA-approved devices and include new cardiomyopathy indications. Add hyperparathyroidism as covered indication for vitamin D testing. Train staff on updated age criteria and new covered services.