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Health NetCommercial · Coverage · Prior Authorization · CA · Pain Management, Oncology, Neurology +6 moreHigh impact

20-435 Medical Policies - 1st Quarter 2020

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

Summary

Health Net updated multiple medical policies for Q1 2020, including new COVID-19 testing guidelines, changes to prior authorization requirements for various procedures, and updates to coverage criteria for DME, nerve blocks, transplants, and other services. Most notably, several procedures were reclassified as not medically necessary or investigational, affecting billing and coverage.

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What to do

immediately · 3 steps
01Billing teams must update prior authorization requirements and coverage criteria for multiple procedures.
02Key changes include: 1) Stop billing E1399 for gait trainers and update criteria for wheelchair repairs using E1399, K0108, K0739; 2) Update coverage for cold pad pumps to 'not medically necessary'; 3) Mark CPT codes 0587T, 0588T, 0589T, 0590T as investigational for tibial nerve stimulation; 4) Flag CPT 64625 and 64451 as not medically necessary for sacroiliac joint interventions; 5) Remove CPT 38206 from transplant billing.
03Update billing system rules and train staff on new coverage criteria to prevent claim denials.

Codes mentioned

E1399E0849E0770E2300K0108K07393820664625644516447964480R06.2D59.5D75.81Z94.83G56.00G56.93M50.00M50.93M54.12M54.13

Original notice

20-435 Medical Policies - 1st Quarter 2020
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
View original ↗

Related changes

See all Health Net changes →
20-438 Medical Policies - 1st Quarter 2020HighNo effective date · Prior Authorization20-437 Medial Policies - 1st Quarter 2020HighNo effective date · Prior Authorization20-947 Medical Policies - 3rd Quarter 2020MediumNo effective date · Prior Authorization20-944 Medical Policies - 3rd Quarter 2020MediumNo effective date · Prior AuthorizationBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesPain ManagementOncologyNeurologyUrologyRadiologyOrthopedicsAllergy & ImmunologyOB-GYNPulmonologyCode E1399Code E0849Code E0770Code E2300Code K0108Code K0739Code 38206Code 64625Code 64451Code 64479Code 64480Code R06.2Code D59.5Code D75.81Code Z94.83Code G56.00Code G56.93Code M50.00Code M50.93Code M54.12Code M54.13

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