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MedicaidCoverageMedium impact

20-947 Medical Policies - 3rd Quarter 2020

Health Net·CA · Pain Management, Infectious Disease, Pulmonology +4 more·Prior Authorization
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This is a quarterly medical policy update from CalViva Health affecting Medi-Cal members in Fresno, Kings and Madera counties. Multiple policies were updated including new criteria for COVID-19 testing, respiratory viral panels, nerve blocks, and various surgical procedures with specific billing code changes.

Action Required

Action needed
Immediately: Billing teams serving Medi-Cal patients in Fresno, Kings and Madera counties must review the complete policy document at the Provider Library to understand specific medical necessity criteria changes. Update billing system rules for the listed procedure codes, particularly noting that codes 0213T-0218T for ultrasound-guided facet injections are now investigational and codes E1399, E1801, E1806, E1811, E1815, E1816, E1818, E1830, E1831, E1840, E1841 for stretching devices do not support medical necessity.

Affected Billing Codes

87632
87633
L8613
L8692
H61.111
H61.112
H61.113
H61.114
H61.115
H61.116
H61.117
H61.118
H61.119
86328
E1399
E1801
E1806
E1811
E1815
E1816
E1818
E1830
E1831
E1840
E1841