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20-437 Medial Policies - 1st Quarter 2020
Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Health Net updated multiple medical policies in Q1 2020, including new prior authorization requirements, coverage changes for various procedures, and updated billing codes. Key changes include new coronavirus testing guidelines, revised DME criteria, and updated coverage for procedures like facet joint injections and nerve blocks.
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What to do
immediately · 2 steps
01Billing team must update systems to reflect multiple policy changes including: 1) Remove CPT 38206 for allogeneic transplants, 2) Mark CPT codes 64625 and 64451 as not medically necessary for sacroiliac joint interventions, 3) Add CPT codes 0587T-0590T as investigational for tibial nerve stimulation, 4) Update DME coverage criteria removing E1399 for gait trainers while adding it for wheelchair repairs, 5) Update ICD-10 codes including new R06.2 for allergy testing.
02Review complete policy document for all coverage criteria changes to prevent claim denials.
Codes mentioned
E1399E0849E0770E23003820664625644516447964480R06.2D59.5D75.81Z94.83G56.00G56.93M50.00M50.93M54.12M54.13
Original notice
20-437 Medial Policies - 1st Quarter 2020
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
Related changes
See all Health Net changes →20-438 Medical Policies - 1st Quarter 2020HighNo effective date · Prior Authorization20-435 Medical 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