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21-558 Medical Policies - 2nd Quarter 2021
Act
immediately
Effective date
Not stated in the notice
Identified
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.
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What to do
immediately · 3 steps
01Billing 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.
02Update 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.
03Review and update prior authorization criteria for gender-affirming procedures, spinal cord stimulation psychological evaluations, and wound care skin substitutes using updated HCPCS codes.
Codes mentioned
930009300593010800618371883719827218372284475925859258692650926519265292653E0316E1399E0328E0329L03.319L03.818L98.499Q4150Q4183Q4190Q4208Q4209Q4210Q4211Q4212Q4213Q4214Q4215Q4216Q4217Q4218Q4219Q4220Q4221Q4222Q4223Q4224Q4225Q4226Q4176Q4237Q4238Q4239K52.0K72.00K72.91K85.01K85.02K85.11K85.12K85.31K85.32K85.81K85.82K85.91K85.92Z76.82K1020Z74.01Z74.3Z78.1Z99.89
Original notice
21-558 Medical Policies - 2nd Quarter 2021
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →21-555 Medical Policies - 2nd Quarter 2021HighNo effective date · Prior Authorization21-556 Medical Policies - 2nd Quarter 2021HighNo effective date · Prior Authorization25-1000 Streamlining Prior Authorization: Simplifying Processes for Better EfficiencyHighEffective Dec 1, 2025 · Prior Authorization24-433 New Claims Edit for Non-Covered Lab ServicesHighEffective Jul 12, 2024 · ReimbursementBrowse every Health Net change in the policy list
Related policy hubs
Health Net policiesCA policy changesPsychiatryNeurologyCardiologyPain ManagementPlastic SurgeryWound CareGeneral SurgeryOB-GYNPalliative CareFamily MedicineCode 93000Code 93005Code 93010Code 80061Code 83718Code 83719Code 82721Code 83722Code 84475Code 92585Code 92586Code 92650Code 92651Code 92652Code 92653Code E0316Code E1399Code E0328Code E0329Code L03.319Code L03.818Code L98.499Code Q4150Code Q4183Code Q4190Code Q4208Code Q4209Code Q4210Code Q4211Code Q4212Code Q4213Code Q4214Code Q4215Code Q4216Code Q4217Code Q4218Code Q4219Code Q4220Code Q4221Code Q4222Code Q4223Code Q4224Code Q4225Code Q4226Code Q4176Code Q4237Code Q4238Code Q4239Code K52.0Code K72.00Code K72.91Code K85.01Code K85.02Code K85.11Code K85.12Code K85.31Code K85.32Code K85.81Code K85.82Code K85.91Code K85.92Code Z76.82Code K1020Code Z74.01Code Z74.3Code Z78.1Code Z99.89