MedicaidReimbursementHigh impact
21-316 New Payment Policies and ICD-10 Code Editing Update
Health Net·CA · General Surgery, Orthopedics, Neurosurgery +3 more·Prior Authorization
Effective date
Jul 12, 2021
We identified it
Jun 20, 2026
Summary
CalViva Health (Health Net) is implementing new payment policies for robotic surgery and three new ICD-10 code edits for Medi-Cal claims in Fresno, Kings, and Madera counties. CPT S2900 for robotic surgical techniques will no longer be reimbursed, and new laterality and mutually exclusive diagnosis code edits will cause claim denials if coding is incorrect.
Action Required
Immediately: Stop billing CPT S2900 for robotic surgical techniques as it will be denied. Update billing software to flag laterality mismatches between diagnosis codes, diagnosis-to-modifier mismatches, and mutually exclusive diagnosis codes per ICD-10 'Excludes 1' notes. Review all claims for correct laterality coding to avoid denial code 255. Access the Provider Library to review full policy details.