MedicaidPrior AuthHigh impact
21-558 Medical Policies - 2nd Quarter 2021
Health Net·CA · Psychiatry, Neurology, Cardiology +7 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health (Medi-Cal) updated multiple medical policies for Q2 2021, affecting prior authorization requirements, billing codes, and coverage criteria across numerous specialties. Key changes include updated CPT codes for ADHD testing, nerve studies, and spinal procedures, plus revised criteria for gender-affirming procedures, pain management, and wound care.
Action Required
Immediately: Billing team must update system to reflect new CPT codes - remove deleted codes 92585 and 92586, add replacement codes 92650-92653 for auditory evoked potential testing. Update prior authorization requirements for ADHD assessments to exclude ECG codes 93000, 93005, 93010 and lipid panel codes 80061, 83718, 83719, 82721, 83722, 84475 when billed with sole ADHD diagnosis. Review and update prior authorization criteria for gender-affirming procedures, spinal cord stimulation psychological evaluations, and wound care skin substitutes using updated HCPCS codes.