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Health NetMedicare Advantage · Prior Auth · Prior Authorization · CA · Pain Management, Gastroenterology, Pediatrics +10 moreHigh impact

20-711 Medical Policies - 2nd Quarter 2020

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

This policy update includes multiple changes to prior authorization requirements, coverage criteria, and billing codes across various medical services. Key changes include new policies for burn surgery and pediatric oral therapy, updates to ADHD assessment criteria, new COVID-19 testing guidelines, and various code additions/deletions that may affect payment.

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What to do

immediately · 6 steps
01Billing team must review all affected policies on the provider website under Resources/Medical Policies.
02Update prior authorization requirements for new burn surgery and pediatric oral therapy policies.
03Add new CPT codes 95700, 95705, 95708, 95717, 95719, 95721, 95723, 95725 for ambulatory EEG.
04Update COVID-19 testing guidelines with new ICD-10 codes J80, J96.01, U07.1, U07.2.
05Mark CPT codes 20560 and 20561 as not supporting coverage criteria for trigger point injections.
06Contact Provider Services within 60 days with questions or claims may be impacted.

Codes mentioned

95700957059570895717957199572195723957259091290913J80J96.01U07.1U07.2E1800E1802E1805E1810E18122056020561

Original notice

20-711 Medical Policies - 2nd Quarter 2020
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
View original ↗

Related changes

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20-709 Medical Policies - 2nd Quarter 2020HighNo effective date · Prior Authorization20-712 Medical Policies - 2nd Quarter 2020HighNo effective date · Prior Authorization26-073 Updates to the Prior Authorization RequirementsHighEffective Apr 1, 2026 · Prior Authorization26-074 Updates to the Prior Authorization RequirementsHighEffective Apr 1, 2026 · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesPain ManagementGastroenterologyPediatricsNephrologyNeurologyRadiologyPlastic SurgeryOB-GYNCardiologyGeneral SurgeryPsychiatryEndocrinologyPulmonologyCode 95700Code 95705Code 95708Code 95717Code 95719Code 95721Code 95723Code 95725Code 90912Code 90913Code J80Code J96.01Code U07.1Code U07.2Code E1800Code E1802Code E1805Code E1810Code E1812Code 20560Code 20561

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