CommercialAdministrativeMedium impact
23-195m Changes to Endoscopy Matrix
Health Net·CA · Gastroenterology, Pulmonology, Urology +1 more·Coding
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
Health Net updated their Endoscopy Matrix effective January 1, 2023, adding 14 new CPT codes classified as either diagnostic or therapeutic procedures. This matrix determines the division of financial responsibility between Health Net and capitated providers for endoscopic procedures.
Action Required
Immediately: ASCs and hospitals must reference the updated Endoscopy Matrix (available in Health Net Provider Library) when receiving referrals for endoscopic procedures to confirm financial responsibility before rendering services. Capitated PPGs should review their Provider Participation Agreement DOFR to determine correct payer. Ensure claims for the 14 new endoscopy codes are submitted to the appropriate payer based on the diagnostic vs therapeutic classification.