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Health NetCommercial · Coverage · Prior Authorization · CA · Bariatric Surgery, Pain Management, Orthopedics +12 moreMedium impact

21-790 Medical Policies - 3rd Quarter 2021

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

Summary

Health Net's third quarter 2021 medical policy update revises a series of medical policies for procedures, equipment and services, including bariatric surgery (CP.MP.37), nerve blocks for pain management (CP.MP.170), sacroiliac joint fusion and injections (CP.MP.126 and CP.MP.166), durable medical equipment (CP.MP.107), neonatal care, and physical, occupational and speech therapy. Under the bariatric surgery policy, CPT codes 43648, 43882, 64595, 0312T, 0313T, 0314T, 0315T, 0316T and 0317T are listed as not supporting medical necessity, and under the neuromuscular electrical stimulation policy, HCPCS code E0744 was added to the codes that do not support coverage criteria. Under the nerve blocks policy, ICD-10 codes K86.0 and K86.1 were added to support coverage criteria for celiac plexus block for refractory chronic pancreatitis.

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What to do

Action · 5 steps
01Before billing bariatric surgery services listed in CP.MP.37: Note that CPT codes 43648, 43882, 64595, 0312T, 0313T, 0314T, 0315T, 0316T and 0317T are listed as not supporting medical necessity, and that gastric balloon, vagus nerve blocking and endoscopic procedures are listed as not supported by medical literature.
02Before billing E0744 under CP.MP.48: Note that this code is listed among HCPCS codes that do not support coverage criteria.
03For celiac plexus block under CP.MP.170: Refractory chronic pancreatitis is an added indication, and ICD-10 codes K86.0 and K86.1 support coverage criteria.
04If required, providers must get prior authorization before services are given.
05Review the complete criteria, references and coding implications for each updated policy on the Health Net provider website, and contact the applicable Health Net Provider Services Center within 60 days with questions about this update.

Codes mentioned

436484388264595E0744K86.0K86.1

Original notice

21-790 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 →
21-792 Medical Policies - 3rd Quarter 2021HighNo effective date · Prior Authorization20-220 Medical Policies - 4th Quarter 2019HighNo effective date · Prior Authorization20-217 Medical Policies - 4th Quarter 2019HighNo effective date · Prior Authorization20-435 Medical Policies - 1st Quarter 2020HighNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesBariatric SurgeryPain ManagementOrthopedicsOB-GYNPediatricsENT (Ear, Nose & Throat)AudiologyPhysical TherapyOccupational TherapySpeech TherapyGastroenterologyNeurologyPsychiatryPlastic SurgeryPulmonologyCode 43648Code 43882Code 64595Code E0744Code K86.0Code K86.1

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