CommercialBilling CodesHigh impact
21-315 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 has implemented new ICD-10 code editing rules and a robotic surgery payment policy effective July 12, 2021. Claims will now be denied for laterality mismatches, mutually exclusive diagnosis codes, and robotic surgery add-on codes (CPT S2900).
Action Required
Immediately: Billing team must update claim review processes to ensure ICD-10 codes match laterality requirements between diagnosis codes and procedure modifiers. Stop billing CPT S2900 for robotic surgery techniques unless specifically allowed by contract. Train coders on new denial code EXwd (denial code 255) for incorrect ICD-10 coding. Review all claims for laterality diagnosis mismatches and mutually exclusive diagnosis codes before submission to avoid denials.