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21-555 Medical Policies - 2nd Quarter 2021
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health Net updated 16 medical policies with new prior authorization requirements, billing code changes, and coverage criteria changes for Q2 2021. Key changes include new CPT codes for ADHD testing that are now not medically necessary, updated HCPCS codes for skin substitutes, and revised criteria for multiple procedures including gender affirming care and spinal cord stimulation.
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What to do
immediately · 4 steps
01Billing team must update billing system to mark CPT codes 93000, 93005, 93010, 80061, 83718, 83719, 82721, 83722, and 84475 as not medically necessary when billed with sole diagnosis of ADHD.
02Replace deleted CPT codes 92585 and 92586 with new codes 92650, 92651, 92652, and 92653 for audiology testing.
03Update HCPCS codes for skin substitutes by removing Q4150, Q4183, Q4190, Q4208-Q4226 and adding Q4176, Q4237, Q4238, Q4239.
04Review all 16 policy updates in Provider Library for complete criteria changes affecting prior authorization requirements.
Codes mentioned
930009300593010800618371883719827218372284475926509265192652926539258592586E0316E1399E0328E0329Z74.01Z74.3Z78.1Z99.89L03.319L03.818L98.499Q4150Q4183Q4190Q4208Q4210Q4217Q4219Q4220Q4176Q4237Q4238Q4239K52.0K72.00K72.91K85.01K85.02K85.11K85.12K85.31K85.32K85.81K85.82K85.91K85.92Z76.82K1020
Original notice
21-555 Medical Policies - 2nd Quarter 2021
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →21-558 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 changesCardiologyNeurologyPsychiatryOB-GYNPain ManagementWound CareGastroenterologyNephrologyPlastic SurgeryDermatologyGeneral PracticeCode 93000Code 93005Code 93010Code 80061Code 83718Code 83719Code 82721Code 83722Code 84475Code 92650Code 92651Code 92652Code 92653Code 92585Code 92586Code E0316Code E1399Code E0328Code E0329Code Z74.01Code Z74.3Code Z78.1Code Z99.89Code L03.319Code L03.818Code L98.499Code Q4150Code Q4183Code Q4190Code Q4208Code Q4210Code Q4217Code Q4219Code Q4220Code 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 K1020