CommercialPrior AuthHigh impact
21-139 Medical Policies - 4th Quarter 2020
Health Net·CA · Pulmonology, Allergy & Immunology, General Surgery +12 more·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net updated multiple medical policies in Q4 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties including oxygen therapy, allergy testing, bariatric surgery, wound care, and various diagnostic procedures.
Action Required
Immediately: Billing teams must review all updated medical policies and update prior authorization workflows for affected services. Update billing systems to reflect new coverage criteria for oxygen therapy, allergy testing, bariatric surgery, and other modified policies. Remove HCPCS Q4111 from wound care billing as it's now covered under different policy. Update ICD-10 code lists in billing software to reflect added and removed diagnostic codes. Contact Health Net Provider Services within 60 days with questions using the provided phone numbers and portals.