MedicaidCoverageMedium impact
21-870 New and Updated Payment Policies
Health Net·CA · Gastroenterology, Family Medicine, Internal Medicine +1 more·Prior Authorization
Effective date
Feb 21, 2022
We identified it
Jun 20, 2026
Summary
Health Net CalViva Health implemented a new payment policy restricting reimbursement for gastrointestinal pathogen nucleic acid detection panels with 12+ targets to only inpatient settings (including inpatient, emergency department, and outpatient hospitals). Outpatient office settings will no longer be reimbursed for these comprehensive GI panels.
Action Required
Immediately: Billing team must update system to restrict billing of comprehensive GI pathogen panels (12+ targets) to only inpatient, emergency department, and outpatient hospital settings for CalViva Health Medi-Cal patients in Fresno, Kings, and Madera counties. Update encounter forms and notify providers that these panels are no longer reimbursable in office settings. Claims submitted for office-based comprehensive GI panels will be denied.