All PlansPrior AuthHigh impact
20-946 Medical Policies - 3rd Quarter 2020
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net released Q3 2020 medical policy updates affecting multiple specialties including new prior authorization requirements for respiratory viral panels, updated criteria for procedures like facet joint interventions and nerve blocks, and revised coverage for various treatments. Multiple new CPT and HCPCS codes were added or modified across different service categories.
Action Required
Immediately: Billing teams must review all updated policies on the Health Net provider website under Medical Policies. Update prior authorization workflows for respiratory viral panel testing codes 87632, 87633, 0098U, 0099U, 0100U, and 0115U with specific Place of Service requirements. Remove HCPCS code L8613 from BAHA billing and replace with L8692. Mark ultrasound-guided facet injection codes 0213T-0218T as investigational. Update mechanical stretching device codes E1399, E1801, E1806, E1811, E1815, E1816, E1818, E1830, E1831, E1840, E1841 as not medically necessary. Failure to comply may result in claim denials.