CommercialReimbursementMedium impact
21-868 New and Updated Payment Policies
Health Net·CA·Reimbursement
Effective date
Feb 21, 2022
We identified it
Jun 20, 2026
Summary
Health Net has updated three payment policies effective February 21, 2022: consultation services will now be reimbursed at corresponding E&M visit levels instead of being denied, 340B drug claims require specific modifiers (JG or TB) for proper reimbursement, and GI pathogen panels with 12+ targets are now restricted to inpatient settings only.
Action Required
Immediately: Update billing practices for three policy changes: 1) Bill appropriate E&M codes instead of consultation codes for physician consultations, 2) Ensure 340B participating providers add modifier 'JG' for reduced rate drugs or 'TB' for informational purposes on drug claims, 3) Restrict billing of GI pathogen panels with 12+ targets to inpatient, emergency department, and outpatient hospital settings only. Review provider manual updates in Health Net Provider Portal and contact Provider Services within 60 days with questions.