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Health NetMedicaid · Coverage · Prior Authorization · CA · General Surgery, Pain Management, Gastroenterology +7 moreHigh impact

21-792 Medical Policies - 3rd Quarter 2021

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

CalViva Health updated 21 medical policies in Q3 2021 affecting prior authorization requirements, coverage criteria, and billing codes across multiple specialties. Key changes include new non-covered bariatric procedures, revised pain management criteria, updated NICU guidelines, and modified therapy requirements for skilled nursing facilities.

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What to do

immediately · 4 steps
01Update billing systems to flag CPT codes 43648, 43882, 64595, 0312T, 0313T, 0314T, 0315T, 0316T, and 0317T as non-covered for bariatric procedures.
02Update HCPCS code E0744 as non-covered for neuromuscular stimulation.
03Add ICD-10 codes K86.0 and K86.1 to support celiac plexus block coverage.
04Review all 21 updated policies on provider website for complete criteria changes.
If missed: Failure to comply may result in claim denials.

Codes mentioned

436484388264595E0744K86.0K86.1

Original notice

21-792 Medical Policies - 3rd Quarter 2021
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related changes

See all Health Net changes →
21-790 Medical Policies - 3rd Quarter 2021MediumNo effective date · Prior Authorization20-712 Medical Policies - 2nd Quarter 2020HighNo effective date · Prior Authorization21-142 Medical Policies - 4th Quarter 2020HighNo effective date · Prior Authorization24-469m Medical Policies - April 2024MediumEffective Apr 1, 2024 · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesGeneral SurgeryPain ManagementGastroenterologyPhysical TherapyOccupational TherapyOB-GYNPediatricsPlastic SurgeryENT (Ear, Nose & Throat)NeurologyCode 43648Code 43882Code 64595Code E0744Code K86.0Code K86.1

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