All PlansBilling CodesHigh impact
21-556 Medical Policies - 2nd Quarter 2021
Health Net·CA · Psychiatry, Neurology, ENT (Ear, Nose & Throat) +8 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated multiple medical policies for Q2 2021, including new policies for TMS treatment, EMG/nerve studies, and nasal valve repair, plus significant updates to ADHD testing codes, gender affirming procedures, and pain management nerve blocks. Multiple CPT, HCPCS, and ICD-10 codes were added, removed, or modified across various specialties.
Action Required
Immediately: Billing teams must update systems to reflect multiple code changes: (1) Mark CPT codes 93000, 93005, 93010, 80061, 83718, 83719, 82721, 83722, 84475 as not medically necessary when billed with sole ADHD diagnosis; (2) Replace deleted CPT codes 92585, 92586 with new codes 92650, 92651, 92652, 92653 for auditory/evoked potential testing; (3) Update HCPCS codes for skin substitutes by removing Q4150, Q4183, Q4190, Q4208-Q4226 and adding Q4176, Q4237, Q4238, Q4239; (4) Add new ICD-10 codes for various conditions including ambulance transport and wound care. Review complete policy documents in Provider Library for detailed medical necessity criteria changes.