MedicaidPrior AuthMedium impact
22-079 Medical Policies - 4th Quarter 2021
Health Net·CA · Gastroenterology, Oral & Maxillofacial Surgery, Orthopedics +5 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health updated multiple medical policies for 4th quarter 2021, adding three new policies requiring prior authorization for gastrointestinal pathogen testing, orthognathic surgery, and osteogenic stimulation. Several existing policies were updated including ambulatory surgery center criteria, epidural injections, and reduction mammoplasty requirements.
Action Required
Immediately: Review and implement new prior authorization requirements for gastrointestinal pathogen nucleic acid testing (CP.MP.209), orthognathic surgery (CP.MP.202), and osteogenic stimulation (CP.MP.194). Update billing system to reflect that CPT codes 66982 and 66984 are now appropriate for ambulatory surgery centers. Train staff on updated criteria for ambulatory surgery during pregnancy and revised reduction mammoplasty requirements for adolescents.