CommercialBilling CodesHigh impact
21-555 Medical Policies - 2nd Quarter 2021
Health Net·CA · Cardiology, Neurology, Psychiatry +8 more·Prior Authorization
We identified it
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.
Action Required
Immediately: Billing 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. Replace deleted CPT codes 92585 and 92586 with new codes 92650, 92651, 92652, and 92653 for audiology testing. Update HCPCS codes for skin substitutes by removing Q4150, Q4183, Q4190, Q4208-Q4226 and adding Q4176, Q4237, Q4238, Q4239. Review all 16 policy updates in Provider Library for complete criteria changes affecting prior authorization requirements.