MedicaidBilling CodesMedium impact
23-014 Bill Correctly to Get Paid for Pulmonary Testing and Skin Substitute Claims
Health Net·CA · Pulmonology, Wound Care, Plastic Surgery·Prior Authorization
Effective date
Mar 15, 2023
We identified it
Jun 20, 2026
Summary
CalViva Health implemented new payment edits for pulmonary function testing claims requiring medical necessity guidelines compliance and for skin substitute claims requiring retrospective billing review. Skin substitutes are now only reimbursable when billed with application CPT codes 15271-15278.
Action Required
Billing team must update systems to ensure skin substitute claims are only submitted when billed with application CPT codes 15271-15278. Review pulmonary function testing claims for medical necessity documentation per policy CP.MP.242. Contact CalViva Health at 888-893-1569 for questions.