CommercialReimbursementMedium impact
20-910 New Payment Policies and Reminder on Correct Coding Guidelines
Health Net·CA · Physical Therapy, Occupational Therapy, Ophthalmology·Prior Authorization
Effective date
Feb 1, 2021
We identified it
Jun 20, 2026
Summary
Health Net is implementing two new multiple procedure payment reduction policies effective February 1, 2021 for therapeutic services and ophthalmology procedures. When multiple procedures are performed on the same day by the same provider, subsequent procedures will be reimbursed at reduced rates (90% for therapeutic services, 80% for ophthalmology diagnostics).
Action Required
Immediately: Billing team must update fee schedules and payment expectations for Health Net claims. For therapeutic services with MPI of 5, expect 100% payment for highest-value procedure and 90% for subsequent procedures same day. For ophthalmology diagnostic procedures with MPI of 7, expect 100% for highest-cost procedure and 80% for subsequent procedures. Update billing system to calculate correct expected reimbursement amounts and adjust patient estimates accordingly.