Medicare AdvantagePrior AuthHigh impact
20-711 Medical Policies - 2nd Quarter 2020
Health Net·CA · Pain Management, Gastroenterology, Pediatrics +10 more·Prior Authorization
We identified it
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.
Action Required
Immediately: Billing team must review all affected policies on the provider website under Resources/Medical Policies. Update prior authorization requirements for new burn surgery and pediatric oral therapy policies. Add new CPT codes 95700, 95705, 95708, 95717, 95719, 95721, 95723, 95725 for ambulatory EEG. Update COVID-19 testing guidelines with new ICD-10 codes J80, J96.01, U07.1, U07.2. Mark CPT codes 20560 and 20561 as not supporting coverage criteria for trigger point injections. Contact Provider Services within 60 days with questions or claims may be impacted.