CommercialReimbursementHigh impact
21-314 New Payment Policies and ICD-10 Code Editing Update
Health Net·CA·Reimbursement
Effective date
Jul 12, 2021
We identified it
Jun 20, 2026
Summary
Health Net implemented new payment policies effective July 12, 2021, including restrictions on robotic surgery billing (CPT S2900) and 340B drug payment reductions for Medicare claims. Additionally, three new ICD-10 code edits were added to verify correct laterality coding and mutually exclusive diagnosis codes, with denials issued for coding mismatches.
Action Required
Immediately: Stop billing CPT S2900 for robotic surgery techniques as it will be disallowed for reimbursement unless contract specifically allows. Billing team must update coding practices to ensure proper laterality coding between diagnosis codes and modifiers, and avoid mutually exclusive diagnosis codes per ICD-10 'Excludes 1' notes. Review all claims for correct laterality matching to prevent denials with code EXwd/255.