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21-139 Medical Policies - 4th Quarter 2020
Act
immediately
Effective date
Not stated in the notice
Identified
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.
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What to do
immediately · 5 steps
01Billing teams must review all updated medical policies and update prior authorization workflows for affected services.
02Update billing systems to reflect new coverage criteria for oxygen therapy, allergy testing, bariatric surgery, and other modified policies.
03Remove HCPCS Q4111 from wound care billing as it's now covered under different policy.
04Update ICD-10 code lists in billing software to reflect added and removed diagnostic codes.
05Contact Health Net Provider Services within 60 days with questions using the provided phone numbers and portals.
Codes mentioned
Q4111C15.3C15.4C15.5C15.8C15.9C37C71.0C71.1C71.2C71.3C71.4C71.5C71.6C71.7C71.8C71.9C72.0C72.1C72.2C72.3C72.4C72.5C72.8C72.9M17.0M17.1M17.2M17.3M17.4M17.5M17.9M19.171M19.172M19.173M19.179M19.271M19.272M19.273M19.279A39.82H35.54R44.1R48.3H54.7N40.1R35.151798
Original notice
21-139 Medical Policies - 4th Quarter 2020
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →21-142 Medical Policies - 4th Quarter 2020HighNo effective date · Prior Authorization21-141 Medical Policies - 4th Quarter 2020HighNo effective date · Prior Authorization20-219 Medical Policies - 4th Quarter 2019HighNo effective date · Prior Authorization20-220 Medical Policies - 4th Quarter 2019HighNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list
Related policy hubs
Health Net policiesCA policy changesPulmonologyAllergy & ImmunologyGeneral SurgeryWound CareNeurologyCardiologyPediatricsOncologyHematologyEndocrinologyUrologyPhysical TherapyOccupational TherapyOrthopedicsRadiologyCode Q4111Code C15.3Code C15.4Code C15.5Code C15.8Code C15.9Code C37Code C71.0Code C71.1Code C71.2Code C71.3Code C71.4Code C71.5Code C71.6Code C71.7Code C71.8Code C71.9Code C72.0Code C72.1Code C72.2Code C72.3Code C72.4Code C72.5Code C72.8Code C72.9Code M17.0Code M17.1Code M17.2Code M17.3Code M17.4Code M17.5Code M17.9Code M19.171Code M19.172Code M19.173Code M19.179Code M19.271Code M19.272Code M19.273Code M19.279Code A39.82Code H35.54Code R44.1Code R48.3Code H54.7Code N40.1Code R35.1Code 51798